Shining A Light On Pacific Children’s High Rates Of Ambulatory Sensitive Hospitalisations In New Zealand: Parents’ Perspectives

The overwhelming statistics and the growing evidence on the burden of ill health experienced by Pacific children in Aotearoa New Zealand (NZ) is difficult to comprehend, particularly when the NZ health system is regarded to be one of the best and of good standard internationally. The persistent high rates of ambulatory sensitive hospitalisations (ASH) for Pacific children in NZ has provided a more contextual and a better perspective of the burden of poor health experienced by Pacific children for many years. ASH for children often result from minor, acute illnesses with abrupt onsets which are arguably preventable with timely and effective interventions in ambulatory and primary health care settings. However the issue is much more complicated for NZ children. The persistent ASH gap between ethnic groups consequently contributes to child health inequality in NZ. ASH are indicators of quality health care received in primary health care settings and reducing childhood ASH is a health priority in NZ. The shocking child health statistics paint a sad and disturbing picture on the health of Pacific children who grew up and have made NZ their home.

The lack of research on the persistent and excessive ASH rates on Pacific children warrants the need for this study. Events related to Pacific children age 1 month – 14 years admitted with a health condition considered preventable were explored in this study, by gaining insights into the perspectives of parents. The aims were to describe parents and children’s experiences, identify healthcare priorities for Pacific children, and explore solutions or what could be done differently to reduce ASH rates for this population group. The research also aimed to enhance Pacific community and nursing capacity by supporting participation in a child health research project.

A qualitative multi-method design informed by a Community-Based Participatory Research (CBPR) approach was utilised in this study. The research involved establishing a partnership between parents, nurses, and myself (PhD candidate) to yield knowledge to better understand Pacific children’s hospital admissions that are considered preventable. The study involved four sequential phases: 1: Development of a research partnership with Pacific nurses in a form of a Pacific Nurses Research Advisory Group (PNRAG) (n=12); 2: Semi-structured interviews with parents (n=25) of children who had a potentially avoidable admission; 3: Parents group meetings (n=5) using nominal group techniques; and 4: Dissemination and translation of findings to inform interventions. Three District Health Boards with high Pacific populations were the localities for the study. Analysis used content and thematic techniques for Phase 2, and nominal analysis processes for Phase 3. Phase 4 is ongoing.

Results: Children’s primary reasons for hospital admissions were, Respiratory (n=9), Skin health (n=8), Oral health (n=4), Other (n=4). Multiple factors contributed to children’s hospital admissions. Significant areas highlighted in the research findings were centred on parents’ limited knowledge on children’s health conditions, lack of confidence voicing their concerns and inadequate support by health workers. Health workforce and health literacy are critical contributing factors. The CBPR approach in partnership with parents and the PNRAG lifted the authenticity of the research. Dissemination: Results from this research are being shared with Pacific nurses, primary care providers, and children’s health providers in anticipation that the insights provided into strategies, methods and interventions once implemented will reduce high rates of ASH and improve Pacific children’s health outcomes.

Conclusion: The collective experiences and perspectives from Pacific nurses and parents of Pacific children provides valuable insights of small and large interventions that, if addressed, has the potential to make a positive impact on the lives of Pacific children and reduce ASH rates by Pacific children.