'It's more than just kale (cough)'. New Zealand Sāmoan Attitudes to Living With Chronic Cough and Healthcare Access

Abstract

INTRODUCTION: Chronic cough is burdensome for individuals and healthcare providers and is a symptom common to a number of health conditions, including bronchiectasis. The prevalence of respiratory conditions particularly bronchiectasis is disproportionately high amongst Pacific people residing in Counties Manukau. Barriers to healthcare access and engagement both practical and cultural, contribute to delayed presentation and advanced illness. AIM: To explore attitudes to cough and healthcare access by Sāmoan adults living in Counties Manukau. METHODS: Semi-structured interviews guided by Talanoa, a Pacific-specific method, were conducted focused on cough duration and characteristics, treatment-seeking behaviours, and healthcare experiences. Data were analysed thematically and framed using the Fonofale Model of Health. RESULTS: Two overarching themes were constructed from seven Talanoa: 'Understanding my cough' and 'healing, curing and coping with cough'. Chronic kale/cough was found to impact on all pou (posts) of the Fonofale health model. Kale/cough management strategies were drawn from Sāmoan and Western health paradigms, perceived as complimentary. Access to specialist services was valued and extended participants' coping repertoire further. Respect and trust shaped relationships with healthcare providers and influenced engagement. DISCUSSION: Models such as the Fonofale health model provide a framework for healthcare providers to better understand the multi-dimensional impact of cough. Recognising the cultural perspectives of populations underrepresented in the health workforce provides valuable insights to re-frame healthcare practice and service to optimise engagement with on-going symptoms such as cough and in supporting chronic conditions.