The effect of a Pasifika intervention on rates of rheumatic fever in South Auckland Pacific communities

The aim of this study is to develop, design, implement and evaluate a new innovative intervention to reduce rheumatic fever for Pasifika communities in South Auckland. This mixed-methods study utilises the Fa’afaletui paradigm. This is a Pacific centred methodology that enables discussion with a range of different and sometimes conflicting perspectives. A co-design approach will be utilised where the community participants and clinicians work together alongside researchers to develop a novel and innovative intervention to reduce the rheumatic fever burden impacting Pasifika communities. Phase two and three of the overall project outline the co-design, development, implementation, and evaluation of the intervention. Phase 2: Designing the intervention and developing the implementation plan. This will include a stocktake of programmes and interventions aimed at reducing rheumatic fever in NZ. This will occur as part of a scoping review to broadly identify the range of approaches used currently and in the past, where they have been implemented and whether they have been successful. Concise summaries of the scoping review results will be produced using a variety of techniques such as PowerPoint presentations, brochures, posters and storyboards. This will aid in informing workshop participants of what has been tried before, what has been successful and what might be useful for their co-designed intervention. Approximately four day-long workshops will be conducted over a period of six months with PPHAG, PPBRN and other relevant Pasifika community members and stakeholders to explore their views of current and past rheumatic fever interventions and to co-design alternatives. • The Pacific People’s Health Advisory Group (PPHAG): This group comprises male and female community members aged in their 20s to their 70s, of mixed Pasifika ethnicities (Samoan, Tongan, Niuean, Cook Islands) with a range of occupations, for example, nursing students, teachers, social workers, broadcasters and retirees. • Pacific Practice-Based Research Network (PPBRN): All PBRN research officers (which include general practitioners, nurses, and receptionists depending on the practice) from South Auckland practices in the Network will be invited to participate in the workshops. Other practice staff members identified by PBRN research officers may also participate, should they wish to do so. • Patients with rheumatic fever and their families: PPBRN practices will recruit Pacific patients diagnosed with rheumatic fever to test and evaluate the intervention. The invitation will also be extended to their extended family members who would like to participate. We will use purposive sampling aiming for a diversity of Pacific ethnicities, ages and other key characteristics of these participants. • Other relevant stakeholders: Other stakeholders including community pharmacists, Primary Health Organisation (PHO) personnel, community members and/or others identified during the study may be invited to participate. The workshops will be facilitated by six members from the Pacific Rheumatic Fever Project research team: • 1 x Senior Lecturer with experience in Pacific community health, health promotion and community engagement. • 2x General Practitioners with vast experience in teaching, general practice, and Pacific health research. • 2x Research Fellows Where possible, workshops will take place in-person (or virtually depending on pandemic restrictions) using cultural protocols and approaches. Dialogue within the workshops will follow Talanga, a Tongan participant-centred approach that means “interactive talking with a purpose” and enables empowering and interactive dialogue towards action. Workshops will begin with short presentations of the current data trends and previous rheumatic fever interventions, such as the Ministry of Health's Rheumatic Fever Prevention Programme, community awareness strategies such as "Take it to Heart" run by Alliance Health Plus and school throat swabbing initiatives such as Mana Kidz. Participants will then collaboratively workshop innovative solutions using their expertise as members of the Pasifika community in South Auckland. Groups may be provided with large sheets of paper and whiteboards to brainstorm, and these data will be collected at the end of the workshop. Once an intervention has been drafted, PPHAG, PPBRN and researchers will collectively refine it via further workshops. Expert reviewers will also contribute to this process to ensure that strategy is feasible and can be implemented in South Auckland. Factors to be addressed in the intervention include what components it entails (e.g. health promotion, education, prescribing, dispensing, patient reminders, family/whanau involvement), who leads it (eg doctor, nurse, pharmacist, team, community-led), and where it takes place (eg health premises, community location). Implementation plan To map the implementation of the final intervention, a framework will be developed using a logic model of change. This will outline the inputs (such as resources, personnel and funding required), activities (encompassing the tasks necessary for implementation), outputs (measures demonstrating implementation has occurred) and short-term outcomes (the expected changes). Phase 3: Intervention implementation and Evaluation The intervention will then be trialled in South Auckland and tested to see how well it works. It is anticipated that Phase 3 will start approximately six months after the conclusion of Phase 2 and implemented and evaluated over a 12 month period. Precise details of the evaluation will depend on the nature of the novel intervention and its characteristics. Study approach This phase will use an implementation science approach, which is a systematic study of the activities that facilitate the successful uptake of an evidence-based health intervention, in this case a strategy and programme to reduce rheumatic fever rates amongst Pasifika in South Auckland. The design of the evaluation of the intervention implementation will be underpinned by a theoretical framework and informed by behavioural change theory, whereby a person’s attitudes, personal or subjective norms and their perceived behaviour controls (not doing what they think is wrong) shape an individual’s behavioural intentions and hence their actual behaviours.