Sāmoan Health Worker Wellbeing in Aotearoa New Zealand

Abstract

A strong Sāmoan health workforce is required to improve inequitable health outcomes for the growing Sāmoan population within Aotearoa New Zealand (AoNZ). However, despite initiatives to increase an underrepresented Sāmoan health workforce, little is known about the wellbeing of these workers or the safety of the spaces they occupy. Existing literature on Sāmoan health worker wellbeing is sparse, superficial, and largely focused on increasing overall Pacific health workforce numbers rather than understanding the lived experiences and support needs of Sāmoan health workers. This research, through two comprehensive studies, aimed to engage with regulated Sāmoan health workers and their communities within AoNZ to explore their wellbeing, how they navigate their roles, what supports are needed for their practice, and help develop safe spaces for new Sāmoan health workers.

Study One involved a scoping review using a broad literature search that included grey literature to capture often neglected Pacific knowledge and create a comprehensive understanding of the literature. Thirty-four sources, including 29 from grey literature, were reviewed. The findings exposed an underrepresented Sāmoan health workforce whose wellbeing is hindered by institutional racism, discrimination, the undervaluing of cultural knowledge, and discourteous additional work. Sāmoan health workers sought improved wellbeing through support to further their education, cultural education and supervision, and strong Pacific leadership.

Study Two used the foundational methodology of Fa‘afaletui alongside Interpretive Description to explore deeper understandings of Sāmoan health worker wellbeing. Participants (n=23) were Sāmoan and represented a collective lens, with experience or the ability to speak to Sāmoan health worker wellbeing. Purposeful sampling enabled perspectives from faife‘au (church ministers), matai (chiefs), elders, parents, health managers, unregulated health workers, healthcare students, and regulated health workers. Data were collected through two fa‘afaletui (meeting for discussion) held in Porirua and Manukau, transcribed verbatim, and analysed initially collectively within the fa‘afaletui and then using reflexive thematic analysis.

From the data, four themes were constructed that described wellbeing and its intricate link with Fa‘aSāmoa (Sāmoan culture) and tautua (service): Theme 1 ‘Leadership—Lighting the Path’ illuminated the Sāmoan values of collective leadership, where pathways to leadership come from tautua, fa‘aaloalo (respect), and alofa (love) and are reciprocated by those who hold leadership positions. Theme 2 ‘Identity and Visibility’ describes the importance of expressing and maintaining Sāmoan identity while working within westernised health systems. Theme 3 ‘Culture Implemented in Service—The Flame’ reflects the talanoa (conversation) of embedding Fa‘aSāmoa into Sāmoan health worker roles and environments, allowing culturally safe and appropriate services. Finally, Theme 4 ‘Self-Care—Stoking Your Own Fire’ reveals the tension between collective cultural expectations and the need for individual self-care and wellbeing.

This Pacific-based and Sāmoan-specific research has shed light on generational understandings of Sāmoan health workers’ wellbeing. Sāmoan health worker wellbeing extends beyond workforce growth and addressing racism and discrimination, to encompassing the ability to maintain and express Sāmoan identity and cultural values within professional practice. Culturally responsive leadership, meaningful approaches to self-care, and Pacific-led health policies are essential to supporting wellbeing, challenging Western-centric systems, and enabling Sāmoan health workers to thrive and continue faithfully serving their communities.