Research proposal

Key Words: Wellbeing, Tongan, Older/Aged/Elderly/Ageing

Background

Internationally people are living longer and are expected to live to their sixties
and beyond. Between 2015 and 2050, the proportion of the world’s population
aged over 60 years will nearly double from 12% to 22% (World Health
Organisation [WHO], 2016). The pace of population ageing is faster now, with all countries facing major challenges to ensure that their health and social systems are ready to cope with this demographic shift (WHO, 2016).

In New Zealand, the number of people aged 65 years and older is also increasing and has nearly doubled between 1981 (9.9%) and 2013 (14.3%) (Statistics New Zealand, 2015). In 2016, the proportion of the population aged 65 years and older (15% in 2016) has a 90% probability of increasing between 21 and 26 percent in 2043, and between 24 and 33 percent in 2068. Results from the 2013 census data showed that of the total population aged 65 years and over, 88% identified as NZ European, 6% as Māori, 5% as Asian and 2% Pacific. While the majority of older people in New Zealand are NZ Europeans, other ethnic groups are projected to increase in population size the next 20 years at much higher rates. Numbers of Pacific peoples are projected to increase the highest and reach 160% (Statistics New Zealand, 2014).

The aim of this proposed study is to explore the perspectives and experiences of older Tongan people with relation to what contributes to their wellbeing. The Pacific population in New Zealand is currently small and relatively young. Since 2006, the Pacific population has grown in both number and proportion of the population (New Zealand Statistics, 2014). In future, it is anticipated that an increased number of ageing Pacific peoples will place great demands on health and support services that would enable them to age well. It is therefore essential that health, social and other services be accountable and are prepared to deliver 2 appropriate and meaningful support for the older members of the Pacific community, taking into account their specific needs and cultural values. The main Pacific ethnic groups that comprise the Pasifika population in New Zealand include Samoan (48.7%), Cook Islands Maori (20.9%), Tongan (20.4%) and Niuean (8.1%). The remaining groups represent a mixture of Polynesian, Melanesian and Micronesian groups such as Tokelauan, Fijian, Tuvaluan and Kiribati peoples.

Literature Review

The initial literature review for this study was conducted using multiple online
databases including MEDLINE (OCLC FirstSearch) and CINAHL and was conducted over August-October, 2016. The focus of the search was on factors
associated with being such as “Pacific, Migration, Indigenous, and being in
minority groups that affect wellbeing”. Search term combination of;
i) “aged/ageing/aging/old people/older people/elderly”;
ii) “wellbeing/wellbeing/well being/quality of life/life satisfaction;
iii) “minority/migrants/immigrants/indigenous”; and
iv) Pacific/ “Pacific Island/South Pacific/Pasifika” were used.

Literature from China, Taiwan, Malaysia, United States of America, Canada, Switzerland, Sweden, Netherlands, Turkey, India, United Kingdom, Australia and New Zealand were identified.

After review and analysis of the 33 articles obtained, three main qualities of
ageing emerged as being significantly associated with the ageing process: “Health and/or Wellbeing”, “Quality of Life (QOL)” and “Successful Ageing”. These three qualities were found to be unique and essential in supporting older people to thrive as ageing invariably involves a decline in functioning, wellbeing and quality of life. Whatever qualities the research examined, predictors of each component (i.e. socio-economic factors, social support, optimism, wellbeing, happiness, depressive symptoms, behavioural variables, health-related variables, life satisfaction, quality of life, physical functioning) were universal, interrelated and overlapping, indicating that they are all important and common qualities of ageing (Cené et al., 2015; Lewis, 2013; Maneze, DiGiacomo, Salamonson, Descallar, & Davidson, 2014; Waugh & Mackenzie, 2011).

Findings from the literature also indicated that other factors such as social
support (Deshmukh et al., 2015; Ibrahim et al., 2013; Phillip et al., 2008;
Wangmo, 2011; White et al., 2009), quality of life (Cené et al., 2015; Mehmet &
Dikmetas, 2012; Waugh & Mackenzie, 2011) and optimism (Lewis, 2013) are
important predictors of wellbeing. Social and cultural factors in particular were
found to be significant factors in predicting wellbeing, quality of life and
successful ageing (Davy, Kite, Aitken, Dodd, Rigney, Hayes, & Emden, 2016;
Maneze et al., 2014; Lotoala et al., 2015; Panagiotopoulos, Walker, & Luszcz,
2013; Zdrenka, Yogeeswaran, Stronge, & Sibley, 2015). What was evident was a lack of research and qualitative studies that examined the views and opinions of older people in New Zealand concerning their health and wellbeing, and in particular a lack of research centred on the perspectives of Tongan older people living in New Zealand. Given these findings, I believe this presents an opportunity to explore the views and opinions of older people about what
influences their wellbeing, and in particular focus this work on Tongan older
people living in New Zealand

Significance and Relevance of the Proposed Research

My motivation for carrying out this study originated from a profound personal and profession concern regarding the wellbeing of Tongan older people living in the Porirua community. As a Tongan male, born and raised in Tonga with an elderly parent visiting New Zealand several times a year, I am familiar with the challenges that Tongan older people face here in New Zealand, particularly in terms of adjusting to their new environment. Previously, I had earlier held a Community Health Advocate role for the Pacific Health Services in Porirua (2008-2011).

This was my first experience in working directly with the Tongan community in Porirua. The pursuit and identification of factors that influence wellbeing remains an area of focus. I am strongly committed to exploring further
with a view that my contribution will provide knowledge to support better
understanding of what older Tongan people are going through during the ageing process. Specifically, I am curious about understanding the factors that
contribute to their wellbeing in particular.

In 2015, the Tongan community in Porirua held their Annual General Meeting
(AGM) which I was invited to attend. One of the agenda items for this meeting
was the appointment of new officers to serve the Tongan community in Porirua for the year July 2015 to June 2016. The majority of members belonging to this community are older people, aged 60 years and over. I was initially shocked and felt humbled to be unanimously elected as the president. Even though I was not very keen at the time, I respectfully accepted the fatongia (responsibility) out of respect for my elders for placing their trust in me. With my current employment as a Public Health Advisor for Regional Public Health, I work with school communities where wellbeing is an important aspect of my work.

In my role as the president of the Tongan community, I have observed Tongan
older people who are at retirement age and over, and found them to be lonely
and commonly without meaningful daily occupations. Again this has been a
motivational factor towards my interest in helping support Tongan older people by examining the impacts of these and other influences and circumstances on the wellbeing of Tongan older people.

Research Gap

As wellbeing became the key focus for this work, I began reviewing whether there was any research on the aspect of wellbeing related to older Pacific people. My findings indicated limited research on the health and wellbeing of older Pacific people living in New Zealand, with none on Tongan older people in
particular. In addition, there was insufficient qualitative research available and
for those studies that did investigate the wellbeing aspect of older Pacific people, not all utilized appropriate Pacific research methodologies. In New Zealand one study (Lotoala et al., 2014) looked at the health and wellbeing of 108 older Pacific people (aged 55-70) in comparison to 6545 other people from various ethnic groups. As mentioned, my findings indicated a lack of qualitative studies undertaken with appropriate Pacific cultural methods and methodologies which are essential to extract meaningful and relevant information about a Pacific person’s views of their own health and wellbeing.
Of the studies that have been identified, ethnic group membership was found to be associated with health outcomes in New Zealand (Blakely, Tobias, Robson, Ajwani, Bonné, & Woodward, 2005; Lotoala et al., 2015). In addition, the disparities in health outcomes between different ethnic groups have been closely linked to differences in socioeconomic status (SES) (Blakely et al., 2005; Lotoala et al., 2014; Ministry of Health, 2015; Sporle, Pearce, & Davis, 2002;). However, after reviewing the literature, there are other factors that are associated with older people’s wellbeing especially for migrants and those in minority groups.

Factors such as health variables including morbidity, life events, ethnic and
cultural factors, social support, quality of life and optimism are perceived to be
just as important or arguably more important predictors of older people’s
wellbeing than economic factors.

Despite the tremendous efforts targeted at improving the health and wellbeing of older people in New Zealand, the deterioration in health and wellbeing outcomes for older Pacific people remains. I believe this proposed research work is a timely opportunity to initiate a qualitative study that will be instrumental in contributing to the knowledge and literature base and will support communication of the perspectives of older Tongan people concerning the actual meaning of wellbeing to them. The research finding will identify factors that contribute to wellbeing of Tongan older people in New Zealand. It is anticipated that the outcomes of this study will raise awareness and support the Tongan community about factors that improves wellbeing of older Tongan people. It is hoped that this research will prompt dialogue in different communities and different levels. For services and agencies it will inform the development of strategies and interventions programs aimed at improving Pacific older people’s wellbeing.

Question

The questions that this study will address are:

1. What does wellbeing mean for older Tongan people living in New
Zealand?

2. What are the influences and experiences that contribute to the
wellbeing of older Tongan people living in New Zealand?

Terms

Older Tongan People: refers to Tongan people aged 60 years and over living in
New Zealand Talanoa: “A personal encounter where people express and share their issues, their realities and aspirations, allows more mo’oni (pure, real, authentic) information to be available for Pacific research” (Vaioleti, 2006, p. 21). Talanoa is a mode of communication that is integral to the way in which many Pacific peoples share information, learn and relate to each other (Otsuka, 2005; Vaioleti, 2006) Kakala: is a name in Tongan given for fragrant flowers and leaves woven together in a special way according to the need of the occasion they are woven for (Thaman, 1997).

Overall Research Design/Methodology

The proposed research will utilise a qualitative research methodology with a
descriptive exploratory approach (Sandelowski, 2000, 2010; Thorne, Kirkham, & O’Flynn-Magee, 2004) to describe Tongan older people’s perceptions of their wellbeing. In recognising the cultural values, beliefs and customs of the target population, the study will be guided by the Kakala – a Pacific Cultural Research Framework by Helu-Thaman (1997) and Talanoa – a Pacific Research
methodology (Otsuka 2006; Otunuku 2011; Vaioleti, 2006, 2011). Vaioleti
(2006) describes Talanoa as Pacific research methodology belonging to the
phenomenological family, along with qualitative research, grounded theory,
naturalistic inquiry and ethnography.

The Kakala research model has been selected as the framework for the design of this proposed research. It provides the blueprint for recruitment of participants, for data input and analysis, and for the distribution and return of the information gathered and analysed.

Design

Setting: The setting will be two geographical urban areas of the greater Wellington region: Porirua and Wellington central. Sampling: Purposive sampling and snowball tactics will be used (Noy, 2008) to recruit potential participants. For this research, I aim to conduct eight talanoa sessions involving Tongans who are 60 years and over, who were either born in
New Zealand or Tonga, and have lived here in New Zealand for more than five
years, ensuring a fair distribution of male and female participants if possible.
Exclusion Criteria: Anyone identified as Tongan under the age of 60 years.
Methods: The data will be obtained from one-on-one in depth talanoa sessions
(n = 8) with the possibility of involving more than one participant in each talanoa session, depending on their living arrangement and their own circumstances.

Individual in-depth talanoa sessions are optimal for collecting data on
individuals’ personal histories, perspectives, and experiences (Vaioleti, 2006;
2011). This method will enable participants to share sensitive and confidential
information. It provides the space for those who are not comfortable sharing
their stories and experiences in a group environment.

The participants will determine the time and location of the talanoa sessions. All sessions will be audio-recorded and then transcribed. The talanoa sessions will be conducted in Tongan, transcribed in Tongan before translating into English.

Each talanoa session will commence with sharing each other’s (researcher and
participant) personal background and stories as a way of finding connections
and ensuring that both parties feel comfortable and encouraged to share their
stories. An important aspect of talanoa is to ensure a mutually respectful relationship exists between the participants and the researchers since the knowledge generated is co-constructed by both based on the information, stories, emotions, interests, ideas and experiences shared during talanoa sessions (Otsuka, 2006;

Otunuku, 2011; Vaioleti, 2006, 2011, 2013). To establish a successful
relationship and rapport with participants, the researcher should be aware of the cultural values and beliefs, and also have knowledge of cultural norms, practices and customs (Otsuka, 2006; Otunuku, 2011; Suaalii-Sauni & Fulu-Aiolupotea, 2014; Vaioleti 2006, 2011, 2013).

Socio-Demographic factors – To describe the characteristics of participants,
socio-demographic factors such as age, gender, country of birth, occupation,
living arrangement, and length of time in New Zealand, preferred language,
married status, religious and cultural affiliation and their connections to Tonga
will be obtained from participants. Individual Talanoa session guide – An open technique will be used with the two research questions guiding the whole talanoa sessions. Following each Talanoa session the researcher will document his summary of the session.

Data Analysis

Data from each talanoa session will be analysed separately using a qualitative
content (Sandelowski, 2000, 2010) and thematic approach (Braun & Clark,
2006), and the cultural framework of Kakala (Taufe’ulungaki & Johannson-Fua,
2005; Thaman, 1997, 2016). Each talanoa sessions will be transcribed and then analysed with the aim of being faithful to the participants’ stories or narratives, and perspectives. The findings from all the talanoa sessions will be examined collectively by applying the following steps:

i) Read and re-read the transcripts in Tongan, make notes of first
impressions before importing it into Microsoft Word.

ii) Transcripts will be translated into the English language taking into
consideration the context and the nuances of the language and the
choice of words used to express thoughts and feelings.

iii) For each transcript, identify words, phrases, sentences and sections
that stood out, then highlight or labelling them under two pre- determined categories such as, “what wellbeing meant to them” and “what influences” that contributes to their wellbeing.

iv) Information from transcripts will then be coded or grouped into
themes or sub-categorised under each of the three preconceived
categories, depending on similar information that are repeated across
the transcripts or seems to have connections

v) This will form the main results of the study.

Ethical Implications

Cultural ethical approval and consent from the Tongan community will be obtained so as to enable them to be informed of the purpose of the study and to determine whether the study would be of value to them. Specifically ensuring that each potential participant is fully informed about the research, and whatever process (including consent) I have to go through with them is transparent, trustworthy and culturally appropriate.
The effects and potential impact on participants in terms of confidentiality and
the sensitivity of the information shared given the small size of the older Tongan population will be considered carefully and taken into account. I will always act in a way that preserves the older person’s ngeia (dignity) and molale (moral) by making sure that the process is culturally appropriate, and emerges from Pacific world views in order to keep synergy with the methodology, and to protect the integrity of the Pacific participants as cultural beings (Vaioleti, 2006).

Participants will be invited to choose a pseudonym to protect their identifiability as the possibility of participants knowing each other is high.

Rigour/Trustworthiness

To ensure rigour and trustworthiness, the following are essential:

Credibility

Spend sufficient time interacting with the participants during the process to gain full understanding of their stories and experiences. It is important and credible to allow participants to review the data analysed so as to ensure that the transcriptions of their interviews are accurately recorded (Cormack, 2000).

Dependability

This will be achieved by creating an audit trail of the decisions I make
throughout the research process that provide a clear rationale for my
methodological and interpretative judgements. For example, keeping a reflective diary with comprehensive notes related to the contextual background of the data, and the motive and rationale for all methodological decisions (RyanNicholls & Will, 2009). The same could be said of reflexivity where a reflective diary can be used for my own on-going reflection as a researcher (Jootun, McGhee, & Marland, 2009). During the research process it is vital for me to have continuous reflection through documenting my own values, views and preconceived ideas which could influence the findings.
Individuals and group talanoa sessions will be conducted in Tongan, and
transcribed into Tongan as soon as the talanoa sessions are completed. They will then be translated in English. Both transcription and translation of the talanoa sessions will be reviewed for consistency in meaning possibility by other Tongans in the education and language field.

Transferability

It is my responsibility as the lead researcher to provide detailed descriptions for the reader to make informed decisions about the transferability of the findings to their specific context. A rich and rigorous presentation of the findings with appropriate quotations will enhance transferability but ultimately the reader will decide whether or not the findings are transferrable to another context.

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