New Zealand Resident Sāmoan Health and Illness Beliefs About Chronic Pain and Healthcare Management: A Qualitative Descriptive Study
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Chronic pain carries considerable impact on individuals, families, and communities in Aotearoa/New Zealand (A/NZ), almost one in five adults experience chronic pain (Ministry of Health, 2019). Chronic pain is a multidimensional experience, with cultural attitudes and beliefs known to powerfully influence the experience, behaviour and management of pain (Pillay, et al. 2015). Ethnic disparities in access to chronic pain services exist in A/NZ (Lewis & Upsdell, 2018), as well as in the efficacy of treatment (Lewis et al, 2021). Counties Manukau is home to the majority of the New Zealand based Sāmoan population. Unique Sāmoan beliefs have been found to influence not only the experience of pain, but also their health interactions and treatment seeking (Mauili et al, 2013). This study aimed to investigate Sāmoan health perceptions and beliefs in relation to pain and how they seek help. Methods: This qualitative descriptive study drew on Pasifika research methodologies including tālanoa/face-to-face conversation and teu le va/nurturing of the relational space. Nine key informants from the Sāmoan community were identified, and eight tālanoa were conducted. A Sāmoan researcher was recruited to consult and inform on cultural nuances and practices, adding to the cultural integrity of the research. Data were analysed thematically using the Braun and Clarke (2020) six phase process. Results: Data were constructed into three main themes: stoicism, strength in connectivity and unbridged worlds. Stoicism describes the predominant belief that persistent or chronic pain should be endured without display or complaint. Strength in connectivity describes the inherent pain coping strategies that are integrated in Sāmoan communities. Unbridged worlds describes the disconnect Sāmoan people feel when accessing and interacting with healthcare services. Conclusion: A/NZ Sāmoan people hold holistic beliefs and perceptions about pain. Pain is attributed to multiple causes, including spiritual, relational, and biological. Contemporary healthcare services are reserved for severe pain from biological causes with the expectation of fast, effective pain relief. This can present conflict with services which focus on pain prevention or management of pain impairments. Chronic pain is more often endured, with help from within the āiga/family and community by use of social gatherings that include, story-telling, laughter, and prayer and, by seeking traditional healing practices like fofō/traditional Sāmoan healer. Findings point to the Sāmoan community facing significant difficulties in accessing pain services, including language and health literacy barriers, limited understanding of chronic pain, and limited knowledge of what services are available and how they can benefit patients. Recommendations for clinicians include a need to foster relationships with Sāmoan individuals and their āiga and greater cultural sensitivity and appreciation of the wider psychosocial context of pain, including spirituality of patients. Furthermore, healthcare services should consider how to adapt and expand to include more Pasifika personnel and to be more accessible and culturally relevant for A/NZ Sāmoan people.