Abstract
Background: Stool testing is used for a variety of clinical indications. The most common of these is to test for colorectal cancer, although it may also be used to detect the Helicobacter pylori bacterium which can result in stomach cancer. In New Zealand (NZ), some ethnic minority groups, chiefly Pasifika and Māori, have lower stool sample return rates in comparison to NZ European/Pakeha. In part, this has resulted in worse outcomes for both cancers. There is evidence to date that strategies to increase participation in stool testing for Pasifika have not resulted in equitable uptake. Despite this, there is a paucity of research into the perspectives of Pasifika in NZ towards stool testing.
Aim: This thesis aimed to examine how stool testing could be optimized for Pasifika living in New Zealand. To do this it explored the perspectives towards stool testing among Pasifika people –including key informant Pasifika health professionals – living in NZ and identified barriers and facilitators to participation in stool testing.
Method: Qualitative, semi-structured, face-to-face interviews were held with four Samoan community participants and three Samoan and Tongan key informants. Two focus group meetings were conducted with Samoan and Tongan community participants. A further eight interviews and four focus group meetings were held with Māori and NZ European community participants. Although data was collected on three different ethnic groups the focus of this thesis is on Pasifika, with results from Māori and NZ European included as a comparison. Although my study is titled: ‘Optimising Stool Testing among Pasifika living in New Zealand, my participants were Samoan and Tongan only. However, for the purposes of this thesis I refer to them as Pasifika. Interviews and focus groups were audio-recorded and transcribed verbatim before analysing the data using a Grounded Theory approach. The thesis is structured around the Fonofale Pacific Model of Health.
Results: Pasifika participants indicated that they were willing to participate in stool testing despite having reservations about hygiene concerns and feelings of shame or embarrassment. Stool testing was seen as a foreign concept and there were strong cultural taboos around discussing it. Pasifika were strongly opposed to mailing stool samples and had a preference for dropping samples at laboratories instead. There was also opposition towards collecting a stool sample in the home setting. Participants indicated that the fear of finding cancer or similar worrying results from a stool test was a reason to not participate in stool collection. Belief in God and the power of prayer were influential regarding dealing with a cancer diagnosis and a justification for refusing non-participation. However, ministers and key church people could be highly influential in encouraging participation in stool testing. Previous negative experiences with health professionals and the New Zealand health system was seen as a barrier to participation for Pasifika. Some participants also discussed language barriers and a lack of clarity in communication from health professionals affecting participation. Participants identified a need for more Pasifika health professionals to encourage engagement with the health system, however, Pasifika key informants did not see this as an issue.
Conclusion: Finding strategies to optimize stool testing among Pasifika living in NZ is multi-factorial. There are many reasons why Pasifika are reluctant to participate in stool testing. The main, underlying factor appears to be a lack of awareness around the purposes and benefits around stool testing and once these are explained effectively, participants believed that they and other Pasifika would be more likely to participate. Additionally, the NZ health system should design and deliver any future programmes based on stool testing with Pasifika consultation. This study addresses a gap in the literature around Pasifika participation in stool testing and aims to help achieve equitable health outcomes for Pasifika living in NZ.