Abstract
Aims
The overall aim of the thesis is to gain an understanding of Pacific peoples’ outcomes and experiences after injury, using data from a Prospective Outcomes of Injury Study (POIS) currently underway in New Zealand. There are two research components; the Quantitative Component aimed at describing and comparing pre-injury, injury related and key outcomes between Pacific and non-Pacific participants 24 months after injury; and the main Qualitative Component which explores the lived experiences of injured Pacific women participating in POIS.
Methods
The Quantitative Component used data collected 3 and 24 months post-injury for 2,256 POIS participants referred to the Accident Compensation Corporation’s (ACC) entitlement claims register. Participants resided in one of five New Zealand regions and aged 18-64 years at the time of injury. Participants identifying with any Pacific ethnicity were included in the analyses. Univariate statistics compared pre-injury, injury related and key outcomes between Pacific and non-Pacific participants; and multivariable analyses were used to generate the relative risks for key outcomes for the Pacific group (with the non-Pacific group as the reference). The Qualitative Component used in-depth face to face interviews informed by the Talanoa Pacific Research Methodology. Interviews were audio recorded and transcribed verbatim. Data was organised using the Framework matrix with assistance from NVivo. Analysis was informed using the Fonofale Model of Pacific Health.
Results
Quantitative Component: There were 150 participants of Pacific ethnicity. There was a prevalence of poor outcomes such as inadequate household income (57%), pain/discomfort (50%), non-recovery (43%) and disability (15%) 24 months post-injury for Pacific peoples. The adjusted relative risk (aRR) of having no problems with anxiety/depression was less for Pacific participants (aRR 0.88, 95% Confidence Interval 0.79, 0.98); that is, Pacific participants were at increased risk of this adverse outcome. There were no other significant differences in risks for all the other outcomes including return to work status.
Qualitative Component: Seven Pacific women were recruited and interviewed out of 15 who reported non-recovery at 24 months post-injury (and consented be a part of the follow up study undertaken in this thesis). The interviews took place six years post-injury for the seven women. Five out of the seven had not recovered by the time of interview and had on-going pain/discomfort and disability. The women identified barriers in the rehabilitation process: personal barriers associated with remaining strong and independent despite disability; cultural barriers in performing their roles to look after their families; barriers with ACC – late payments, unexplained cease in payments, too much information and too many requirements from ACC, and also a lack of information about their ACC entitlements; ethnicity of home helpers, and barriers with the health services – wrong medical treatment, pressure to return to work and lack of understanding of the health system. Family was the foundation of support for all the women.
Discussion
Both the research components show that anxiety/depression and pain/discomfort are concerns for injured Pacific individuals. It appears that Pacific peoples are returning to work despite being burdened by poor health, disability and socio-economic outcomes. The provision of culturally appropriate care and a greater understanding of both ACC and health services processes, and Government multi-sectoral support can help improve injury outcomes for Pacific peoples.