Student: Ronald Puni
Supervisors: Dr. Lynley Cook, Dr. Gillian Abel
Sponsor: Partnership Health
There is evidence that Pacific people, along with other populations in New Zealand, have a reduced accessibility to primary care services. This is concerning as Pacific people have a greater burden of disease in comparison with the total population, and poor access could compound inequalities in health.
Access can be defined as the degree to which individual and groups are able to obtain needed primary care services. There are many factors that influence access, with cost being the most frequently cited barrier to access for minority populations including Pacific people. However it is clear that factors other than financial barriers must be operating to explain reduced utilisation of services.
- Identify non-financial factors (social, environmental and organisational) in general practice that act as barriers to accessing these services for Pacific people
- Identify non-financial strategies (social, environmental and organisational) that mainstream general practice could adopt to make their practices welcoming and more accessible for Pacific people
Three focus groups were conducted with Pacific people in English. One group was Youth orientated aged 17-25; the second group was community based with individuals 25+ and a third group was held with Pacific Health Workers (PHW). All three groups were mixed male and female. Ethnicities that were present were Samoan, Tongan, Niuean, Fijian, and Cook Island.
The discussions were facilitated by a Pacific researcher who is experienced in conducting focus groups, and was supported by a Pacific tertiary student undertaking a Summer Studentship.
Participants were sampled purposively. Initial participants were approached and snowball sampling was used to invite additional participants into the study. All three focus groups were audio taped then transcribed. The transcriptions were then thematically analysed to identify any themes concerning non-financial barriers to mainstream GP services and any non-financial strategies to improving access.
A total of 20 participants were recruited for the three focus groups, there were 8 PHWs, 6 Community participants and 6 Youth participants. There was one male in each of the PHW and Community groups and three males in the Youth group; the remaining participants were female.
Barriers identified were communication, personal barriers and structural barriers.
Communication barriers included language, which was identified by all three focus groups as a barrier to GP services. Limited vocabulary in English often meant it was difficult to describe their concerns to the GP. Participants also expressed difficulty in understanding medical terms, which was not restricted to those born overseas, with one participant feeling “dumb” in the fact that she was New Zealand born but could not understand what was being said.
Proper explanation of treatment was also identified as a barrier. Failure to properly inform the patient of realistic outcomes of the treatment lead to high expectations in terms of recovery, and posed a barrier to access. When those expectations were not met it deterred some patients from going to the GP and some would instead resort to alternative medicines which were often publicised by influential members of the community. These were seen as ineffective and detrimental to their health as they were no longer taking proper treatment. Those who faced language barriers were identified by one participant as being more susceptible to such “scams” as they were unable to understand the ingredients on the packaging of the alternative medicines.
Personal barriers refer to one’s beliefs, experiences and values which prevent one from accessing mainstream GP services. Participants expressed certain emotions which acted as personal barriers towards access. The participants mentioned several emotions. Embarrassment arose within the participants over debt or over exposure of the body; fear of the unknown or fear due to the exposure of immigration status or fears over privacy and confidentiality. Confidentiality was regarded as being a relevant issue for pacific people, as pacific communities were relatively small, which lead some participants to request workers outside the family and sometimes outside their own communities.
Differences in priorities were also seen as a personal barrier: different family obligations, employment or just “putting it off” until the condition worsened, were some reasons identified. In the case of employment one participant questioned whether they could afford to take the time off before making an appointment.
Some participants reported that past experiences also dictated access. For example, some participants did not go to the GP when first falling sick because in the past they had been given paracetamol, something which they could have done themselves without incurring a fee. Traditional medicines were also sought due to past experiences, where modern medicines were found to be ineffective. One example was of a participant flying to the Cook Islands to give her child a traditional bath to cure her of her skin ailments which was found to be successful.
The participants also identified several structural barriers. The receptionist was recognised as being important as they were the “first point of contact.” Some receptionists were reported to have abrupt mannerisms which some believed acted as a barrier. However, it was unable to be identified if their mannerisms were racially motivated.
Availability was also identified as a structural barrier. Several participants said that when they had gone to see their registered GP, they had been unable to see them and were either transferred to another GP or incurred a long waiting time ranging from a few days to two weeks. One participant had a “back-up doctor” where she was registered as a casual, and went there when her usual GP was unavailable.
Several non-financial factors have been shown to influence access to mainstream GP services including barriers to communication, personal and structural barriers. If health inequalities are to be reduced by increasing access to GP services, then these barriers must be addressed, and training in cultural competency must be undertaken to ensure better access for Pacific people.