National Ethics Advisory Committee
Kāhui Matatika o te Motu
Many Pacific individuals and families continue to experience health disparities and face financial, cultural, logistical, physical and linguistic barriers to their access to and use of services across the health and disability sector (Ministry of Health 2014a).
These barriers are key reasons why Pacific peoples[1] are not benefiting from health services as much as other groups (Tobias and Yeh 2009). One strategic priority of the New Zealand Health Research Strategy (Ministry of Business, Innovation and Employment and Ministry of Health 2017) is to ‘invest in research that results in equitable outcomes for Pacific peoples and helps them to lead independent lives’.
The term ‘Pacific peoples’ does not refer to one homogeneous group of people. Rather, it refers to cultures, heritages, languages and diverse communities whose ethnic heritage and cultures come from Polynesia, Micronesia and Melanesia. The diversity can be both ethnic and national; the term includes people born in the Pacific region and those of Pacific heritage who were born in New Zealand. These Standards use the term ‘Pacific peoples’; the terms ‘Pasefika’ (Samoan), ‘Pasifika’ (Niuean and Tokelauan) and Pasifiki (Tongan) are also used in Aotearoa New Zealand.
Pacific communities have an integrated and holistic perspective of health and wellbeing. Pacific concepts of health include an interconnectedness between beliefs and values, as well as between cultural, spiritual, emotional and social aspects, and a view that health and wellbeing are often influenced by family and community, specifically in relation to health and illness. Pacific health research must be underpinned by an understanding of these concepts, and should be aimed at obtaining data that has the power to identify and reduce inequity across populations, improve Pacific health outcomes and strengthen the Pacific health and disability workforce.
Pacific health research creates knowledge and understanding essential for improving the health of Pacific peoples, improving health equity and creating healthy Pacific communities. Pacific research encompasses various approaches to integrating cultural worldviews, beliefs, practices and concepts, including indigenous Pacific knowledge systems, conceptual frameworks and models of health such as fonofale (Pulotu-Endemann 2001). Pacific frameworks and methodologies provide for the perspectives of Pacific peoples to be engaged with and represented in culturally appropriate and meaningful ways. In research that targets the Pacific population, relevant Pacific groups should participate in all levels of decision-making about and implementation of the study and dissemination of results.
These Standards highlight significant issues that researchers of both Pacific and non-Pacific ethnicity should be aware of when conducting research with Pacific peoples. The Standards promote research that empowers both researcher and researched. They acknowledge that Pacific studies will be diverse, and that researchers should frame them and shape them according to changing Pacific contexts, and the context of the research. Specifically, these Standards focus on the consultation process for research that involves Pacific peoples or addresses their health and disability concerns, prioritising meaningful and reciprocal engagement.
Pacific peoples use both Pacific and non-Pacific primary health care services. Pacific primary care or community-based providers include general practitioner (GP) services, disability support services and mental health providers. Capacity and capability building is critical to improving Pacific health outcomes through research (Ministry of Health 2014a).
Many Pacific individuals and families continue to experience health disparities and face financial, cultural, logistical, physical and linguistic barriers to their access to and use of services across the health and disability sector. These barriers are key reasons why Pacific peoples are not benefiting from health services as much as other groups. Therefore, it is important that research contributes to enabling Pacific peoples to lead longer, healthier and more independent lives and ensuring that Pacific peoples realise their right to health equity.
4.1 Researchers should acknowledge that Pacific people’s engagement in health research can be influenced by many factors, including:
4.2 Researchers must ensure that their research involving Pacific peoples has cultural rigour; that is, that it involves Pacific peoples at an early stage in the research design, and in the governance, management, implementation and analysis of the research.
4.3 Researchers must ensure that their research involving Pacific peoples is conducted in safe and enabling research environments that demonstrate competent practice by:
4.4 A research protocol must demonstrate cultural rigour, and be developed only after the researchers have established meaningful and reciprocal engagement with ethnic communities involved.
For research to have cultural rigour researchers must:
4.5 Pacific health research protocols must describe how the study will address the inequities in health outcomes that Pacific peoples face.
4.6 Researchers involved with Pacific peoples must understand Pacific dimensions of health (eg, family, spiritual, emotional, physical and environmental dimensions) and how these dimensions interact. To enrich their understanding, researchers should engage Pacific partners, including throughout the life cycle of their research.
4.7 In the case of research that involves a specific Pacific community, researchers must consult with that community’s leaders when designing the research. Researchers must carefully consider who it is best to engage with, to ensure that those involved have sufficient knowledge to play a meaningful role.
4.8 In the case of research involving significant participation of Pacific peoples or that will have a significant impact on Pacific peoples, researchers must seek the appropriate involvement of a Pacific researcher, expert or advisory group with Pacific representation.
4.9 Researchers must give Pacific peoples adequate opportunities and resources (including time and translations and interpreters as necessary) to allow them to become familiar with the processes and potential risks and benefits of the research.
4.10 Researchers must take protective measures to safeguard indigenous Pacific knowledge and knowledge holders appropriately.
Where research involves Pacific peoples or addresses health and disability concerns of importance to Pacific peoples, researchers should build their cultural knowledge of Pacific communities and their values, especially those key concepts and principles that promote wellbeing along a continuum that acknowledges the physical, spiritual, mental, psychological and emotional dimensions of human beings. In general, within the Pacific worldview, wellbeing is achieved when all aspects of an individual and collective are in balance, in harmony and integrated, and co-exist with environments, kinship and support systems, language, the fulfilment of roles and responsibilities, and a recognition of mana and tapu (Peteru 2012).
4.11 Researchers involved with Pacific peoples should seek strong and enduring engagement with Pacific communities and consumers, to ensure research responds to the health needs of Pacific peoples. They should undertake consultation with appropriate community leaders, including those active in serving Pacific peoples in churches, clubs, academia, elder communities and youth communities; Pacific health experts; and Pacific providers and services.
Pacific research methodologies provide good-practice examples of how to engage with Pacific consumers and communities in a New Zealand context. For example, the talanoa methodology (United Nations Framework Convention on Climate Change Secretariat 2018), acknowledges the importance of respect, respectful spaces and relationships when undertaking research.
4.12 When involving Pacific communities, researchers should incorporate reciprocity (eg, the exchange of skills and resources with data, knowledge and wisdom) as a way of establishing good relationships between themselves, participants and the community, ensuring safety and avoiding exploitation and harm (HRC 2014b). Researchers must be aware, however, that certain methodologies, such as research conducted in group settings, may expose participants from small Pacific ethnic groupings (eg, Fijians in Wellington or Rotumans in Lower Hutt) to subsequent harm. Where information is shared among participants, researchers and participants must be aware of confidentiality and privacy.
4.13 Meaningful and reciprocal engagement aims to establish and maintain long-term relationships. Researchers should expect to be asked to give back to the community in culturally appropriate ways before, during and after their research. Researchers should:
4.14 Researchers should aim to disseminate their research findings widely and spread knowledge, awareness and understanding of Pacific health issues, to support provider development and implement health policies emanating from research.
[1] The term ‘Pacific peoples’ is unique to use in New Zealand by government agencies to denote peoples, other than Māori, who were born in and/or reside in New Zealand and they are descendants of nations from within the Pacific Ocean.
