Two young Tongan researchers  in Auckland have teamed up to take on two major health issues facing Pacific and Māori people - rheumatic fever and gout. Postdoctoral research fellows Dr. Siobhan Tu’akoi and Dr. Samuela 'Ofanoa launched their research projects this year in South Auckland communities, funded by the Health Research Council of New Zealand.

Dr. Tu’akoi who comes from Holonga, Tongatapu, was awarded a $487,000 Pacific health postdoctoral fellowship to address rheumatic fever inequities, with a series of innovative community co-design interventions for a period of three years.

Dr. 'Ofanoa from Felemea, Ha’apai and Vaimalo, Vava’u, was granted $469,657 to research Pacific gout intervention, to improve Pacific men's understanding of gout and urate-lowering therapy, also for a period of three years.

“We want to make sure that our communities are leading the way, rather than those considered to be so-called experts,” said Dr. Tu’akoi. “I think the best way you find out that is by actually talking to them and seeing what their views are.”

Both rheumatic fever and gout remained significant issues in Aotearoa, New Zealand.

The researchers approached a Pacific advisory group in South Auckland, wanting to identify the most concerning health issues. They named rheumatic fever and gout as largely affecting Pacific and Māori people in their communities.

Pacific children prone to rheumatic fever

Dr. Tu’akoi said recent research show Pacific children are 80 times more likely to develop acute rheumatic fever and Māori 36 times more likely, compared to non-Māori and non-Pacific children. They are also more likely to experience recurrences, more likely to develop the disease and more likely to die from rheumatic heart disease.

Although a range of interventions and initiatives have been implemented over time, rates have not shown any long-term reduction. Dr Tu’akoi saw innovative models of care, designed and led by Pacific communities, are needed to address the significant health inequities faced by Pacific people.

Her research will focus on a co-designed social-media based intervention, aimed at improving health literacy and awareness for Pacific peoples in Auckland.

“We are really trying to show that this is what the people are saying that the current state of things aren’t working and haven’t been working for a long time.”

Building on from her previous scoping research, the new research project will allow a greater focus on what communities think will work, through workshops and implementing initiatives. “Mostly it’s about getting ideas from our communities and making sure that they're leading the intervention design.”

Reducing stigma around Gout

Dr. Ofanoa said allowing the community to help drive the research through co-design, will likely lead to increasing awareness and understanding of gout.

With a high prevalence in the Pacific community, particularly for younger Pacific men aged 18 to 40 years, partnering with the community was key to shifting attitudes around the stigma associated with the disease.

Often linked to rich foods and high intakes of sugary drinks and alcohol, research has shown Pacific and Māori people are genetically predisposed to gout, rather than lifestyle and diet as the main contributing factors. Symptoms include severe pain in the joints, resulting from high levels of uric acid, which can form crystals that lodge in the joints, debilitating sufferers.

“I think for gout, the talanoa (discussion) is usually around dietary causes and triggers”, said Dr. Ofanoa.

“Over time what we’re seeing in studies is that although diet does contribute a small amount to having high uric acid … there are other stronger contributing factors.”

He said a recent study that looked at dietary causes showed this contributed to just ten percent. “It’s sort of a deficit way of thinking, which creates a narrative that gout is their fault because of what they eat. This contributes to stigma.”

Dr. Ofanoa believe that gaining an understanding around managing the disease with medications would lead to a better quality of life. More recent studies around genetics show Pacific and Māori men are more likely to get gout younger than non-Pacifi and non-Māori.

“We need to promote understanding of gout in a more strengths-based and uplifting approach to support young men’s knowledge of the main causes. For example our ancestors were navigators, so we're more likely to hold a lot of things in our bodies, such as uric acid, to protect us from certain diseases.”

A quantitative survey will measure gout understanding and predictors, and community engagement will take place through talanoa. Dr. Ofanoa will use an innovative and trusted means of engagement, to ensure young Pacific men are in setting that’s familiar and one in which they are confident.

“I want to be able to invite them to a game of touch rugby and have a barbeque, to foster and build relationships. It’s getting that trust, and from there we'll start looking at some of the issues around understanding."

“Because it's co-design, it’s working alongside Pacific men, to help them drive the research and be empowered. From there moving on to the next part of the research, it’s about co-creating resources and ensuring Pacific men are key decision makers throughout the entire process.”