Download 2.8 Tongan Community Workforce Development

Tongan Community Action Programme – Phase 2
Tongan Community Action Programme
Phase 2
Final Report
13 September 2008
Prepared for HealthPAC
By Chris Mene, Project Facilitator and Principal Investigator
With
Bridget Chiwawa P.G.Dip Diet, BSc Nutrition
Kirsty Donaldson MPH, BA, RN
Anne Trappitt NZ Reg Dietitian, BHSc
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Tongan Community Action Programme – Phase 2
Acknowledgements
Malo e lelei, Talofa lava, Warm Pasifika Greetings,
On behalf of the Heart Foundation of New Zealand we wish to sincerely thank the many people
and organisations who participated and supported this Tongan Community Action Project.
Malo aupito to the participating families and the Christchurch Tongan Community Association.
Thank you for placing your trust in this partnership and taking a proactive leadership role on
behalf of yourselves and community. You have served your community as champions of health
and we wish you the very best on your individual and collective journeys from here.
Fa’afetai lava to the Canterbury Pacific Community Reference Group (CRG) for providing
valuable counsel and direction for this project. Thank you also to the Christchurch office of the
Ministry of Pacific Island Affairs for the administrative support you provided to the CPCRG and
the ongoing advisory support to the project management team.
We want to acknowledge the following people and organisations that have made this project the
dynamic community action project that it became.
 Cancer Society
 Canterbury Community Trust
 Canterbury District Health Board
 Christchurch City Council
 Ministry of Health
 Heart Foundation Committee (Christchurch)
 Partnership Health Canterbury
 Pacific Trust Canterbury and Pacific Health Clinic
 Rowley Community House
 Sport Canterbury
Special thanks to:
 Dr Alistair Humphrey
 Professor Ann Richardson
 Dr Api Talemaitonga
 Catherine Robinson
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Duncan Edwards
Lily White
Manu Sione
Marcelino Taulango
Martin Witt
Michael O’Dea
Tokanga Vehikite
Vivienne Daley
Community and Public Health
Otago School of Medicine
Pacific Health Clinic
Canterbury District Health Board
(Previously at Sports Canterbury)
Student, Otago School of Medicine
‘Gardening Guru’
Previously at Pacific Trust Canterbury
Group fitness instructor
Cancer Society
Partnership Health Canterbury
Project facilitator & co-ordinator
Pegasus Health Group
Malo aupito, Fa’afetai lava, Thank you
_______________
Chris Mene
________________ ________________ _______________
Anne Trappitt
Bridget Chiwawa
Kirsty Donaldson
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Tongan Community Action Programme – Phase 2
Table of Contents
Acknowledgements .................................................................................................................2
Abbreviations ..........................................................................................................................4
Executive Summary ................................................................................................................5
Recommendations ..................................................................................................................7
Part One – Context and structure ............................................................................................9
1.1
1.2
1.3
1.4
1.5
1.6
Introduction..................................................................................................................9
Purpose .....................................................................................................................10
Objectives..................................................................................................................11
Methodology ..............................................................................................................11
Tongan Community Action Project Logic Model.........................................................14
Current situation ........................................................................................................15
Part Two – Activities and Outcomes ......................................................................................16
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
Knowledge and awareness of smoking on health ......................................................16
Physical activity sessions ..........................................................................................20
Awareness of Key Messages in HEHA ......................................................................26
Healthy Shared Breakfasts ........................................................................................34
Commitment to Healthy Lifestyles .............................................................................37
School Holiday Programmes .....................................................................................45
Edible Gardens..........................................................................................................47
Tongan Community Workforce Development ............................................................50
Feedback from Tongan Families ...............................................................................54
Part Three – Sustainability ....................................................................................................55
3.1
3.1.1
3.1.2
3.1.3
3.2
3.2.1
3.2.2
3.2.3
Long term outcomes (3-5years) – Sustaining change ................................................55
Sustaining change through Leadership ..................................................................55
Sustaining change through learning .......................................................................57
Sustaining change through communicating............................................................57
Increased Community Connectedness ......................................................................59
High level of community support ............................................................................59
Partnership Health Canterbury...............................................................................60
Professional Relationships .....................................................................................61
Part Four – Discussion, Conclusions and Recommendations ................................................62
4.1
4.2
Discussion - Process Success Factors ......................................................................62
Recommendations .....................................................................................................74
Part Five – Bibliography ........................................................................................................76
Part Six – Appendices ...........................................................................................................77
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Tongan Community Action Programme – Phase 2
Abbreviations
BMI
BP
CATINC
CCC
CPCRG
CPN
CTCA
CV
HDL
HeLP
HEHA
LDL
MoH
NHF
PHC
PHO
PMR
PTC
SIA
TC
TCAP2
Body Mass Index
Blood Pressure
Community Action To Improve Nutrition Capacity
Christchurch City Council
Christchurch Pacific Community Reference Group
Certificate in Pacific Nutrition
Christchurch Tongan Community Association
Cardiovascular
High Density Lipoprotein cholesterol
Healthy Lifestyle Pasifika Project (Wellington)
Healthy Eating Healthy Action
Low Density Lipoprotein cholesterol
Ministry of Health
National Heart Foundation of New Zealand
Partnership Health Canterbury
Primary Health Care Organisation
Performance Monitoring Report
Pacific Trust Canterbury
Services to Improve Access
Total Cholesterol
Tongan Community Action Project Phase 2
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Tongan Community Action Programme – Phase 2
Executive Summary
This is a summary of the Tongan Community Action Programme – Phase 2 (TCAP2)
intervention. The duration of this project was for 18 months and covered the period from
September 2006 to April 2008.
This report incorporates information on:
 Current status at final data collection,
 Data analysis in progress,
 Short and medium term outcomes,
 Sustainability streams (leadership, learning and communications)
The long term outcomes for the TCAP2 (see logic model 3-5years) are to:
 Increase health of Tongan community in Christchurch
 Reduce Health inequalities
 Sustain change
 Increase community connectedness
This will be achieved by:
 Improving nutrition
 Reducing obesity
 Increasing levels of activity
Notable features of this project include:
● Collaborative ‘Community Action’ approach
● Early, meaningful and ongoing engagement with Tongan community leadership and
diverse stakeholder advisory groups
● Nutrition and Physical Activity focus for intervention to improve the health of the Tongan
community in Christchurch
● Achieving ethics approval status for two years - obtained September 2006
● 12 month (October 2007) data collected from 35/40 consented participants. At that time
one participant had died, two had moved from Christchurch and two chose to exit the
project. A second participant died earlier this year.
● 18 month data collected over April and May 2008. This data will be further analysed and
will be compared to the baseline data to be reported in the Ethics report and MoH
evaluation final report due September 2008.
This report provides information on the current situation for participants of the TCAP2 and
extension of the programme that has developed through the Free Church of Tonga and the
Tongan Wesleyan Church. Along with the primary TCAP community participants both church
groups continue to gather for shared meals, breakfasts, nutritional instruction and exercise
sessions.
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Tongan Community Action Programme – Phase 2
Current status at 18 months
Current status at final data collection (18 months) have been identified through interim
information derived from the five data collection periods.
Total Cholesterol/High Density Lipoprotein cholesterol (TC/HDL) ratios
 13 out of 25 participants had TC/HDL ratios <4.5 at baseline and at 18 months
 6 participants improved their TC/HDL ratios at 18 months.
 5 participants had TC/HDL ratios that went from within the normal range at baseline
to being elevated at 18 months.
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The proportion of the 26 participants with a BMI higher than 40kg/m2 fell from 30% to
15% by 18 months
19 out of 29 participants had TC/HDL ratios <4.5 at 18 months
14 out of 28 participants had glycated haemoglobin <6% (non-diabetic)
17 out of 26 participants had triglyceride levels <1.7mmol/l
21 out of 25 participants had HDL levels >1mmol/l
7 of the 26 participants had normal LDL levels <2.5mmol/l
Identification of high risk participants:
 14 out of 28 had glycated haemoglobin >8% indicating an increased risk of diabetes
 17 out of 29 had serum glucose > 6mmol/l indicating an increased risk of diabetes
 21 out of 25 had elevated total cholesterols (>8mmol/l) indicating an increased risk of
heart disease
 19 out of 26 had LDL >2.5mmol/l, indicating an increased risk of heart disease
 21 out of 26 participants were obese (BMI >30kg/m2)
Awareness of the importance of Healthy Food:
 Increase intake of fruit and vegetables
 Healthier meals made at home
 Reduction in households consuming high fat and/or salt specialty breads
 Most households reported having cooked porridge and breakfast cereals 1-4 times
per week
 Most households have basic equipment and appliances for preparation of healthy
meals
 Food purchasing patterns were good with most families buying food once a week
 Frying as a cooking method has decreased
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Tongan Community Action Programme – Phase 2
Recommendations
The following recommendations are made for community and government health organisations
working with the Tongan community. These recommendations may also have relevance to
working with other Pacific nations groups.
The following recommendations are encouraged for future projects that have a focus on:
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increasing health in Tongan communities,
Reducing Tongan health inequalities,
Increasing Community Connectedness, and
Research and development pertaining to Tongan communities in Aotearoa New
Zealand.
Increased Health in the Tongan Community (Primary focus: 40 consented participants)
Community Development and Support
 Continue development and support for community workforce as it enhances local
leadership.
 SIA worker provides capacity for sustained long term outcomes and is a priority
being met by Partnership Health Canterbury (PHO)
 Continue developing and supporting local leadership for ownership, motivation and
mentoring.
 Support and utilise facilitators with bi-lingual capabilities and development of bilingual resources recognising learning preferences of that community of interest.
 Supporting the brokering of linkages to develop community capacity.
Access
 Support awareness raising and community engagement through local leaders
communicating in their own language and community channels. This is enhanced by
utilising simple, visual & culturally appropriate resources.
 Continue resourcing areas that enhance access to health including availability, time,
costs, lack of transport, childcare, knowledge and skills
 Community Action approach encourages and provides for flexibility, innovation and
responsiveness. Encourage initiatives supporting participation in the process of
preparing healthy food
 Engagement with Primary Care is an important part of future planning for PHO’s
Reduced Health Inequalities (Secondary focus: Christchurch Tongan Community)
Tongan Community Engagement / Participation
 Best practice consultation is extremely important for Pasifika focused initiatives.
 For effective Guided Decision Making it is critical to engage Pasifika stakeholders
early, meaningfully and ongoing through project.
 For effective consultation allow flexibility in timeframes.
 Consider community cultural frame and appropriateness when menu planning.
 Supporting Community Action by developing a commitment to role modeling healthy
food at every opportunity. A Community Development approach will strengthen
linkages and relationships for sustainable change.
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Tongan Community Action Programme – Phase 2
Increased Community Connectedness (Tertiary focus: Community Stakeholders)
Partnerships / Connectedness
 Pasifika community stakeholders benefit from developing organisational capability.
 Edible gardens and related key messages are effective components of nutrition
focussed initiatives.
 Synergies are achieved by organisations taking a strategic approach to funding.
 Continue interagency collaboration for connecting, leading and communicating
initiatives.
 Strengthen leadership coordination in order to facilitate whole community approach.
 Target funding support and resources to support high needs communities and
organisations take a strategic approach to apply for funding to support these groups.
 Resource co-ordination between partner organisations.
 Resource networking opportunities for Pasifika community stakeholders.
Research and Development
 Evidence recorded so no similar projects may not need to replicate with ethics research
component. Link future projects to General Practices for sustainability.
 Future projects consider ethics process with respect to end outcomes desired for the
community of interest of each project.
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Tongan Community Action Programme – Phase 2
Part One – Context and structure
1.1
Introduction
This is a summary of the Performance Monitoring Return (PMR) for the Tongan Community
Action Programme – Phase 2 (TCAP2) intervention. It is intended to be read in conjunction with
the previous PMR reports covering the period from 1 October 2007 to 13 April 2008. Some
sections from the previous report have been retained where relevant to the ongoing intervention
and evaluation.
This PMR includes a progress report incorporating information on:
 Current status at final data collection,
 Data analysis in progress,
 Short and medium term outcomes,
 Sustainability streams (leadership, learning and communications)
12 month data - Short term Outcomes
12 month data provided information towards the effectiveness of the intervention towards short
term outcomes. This information is summarised below.
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According to respondents some positive changes have been made towards healthier
food choices.
The respondents demonstrated an awareness of the importance of physical activity.
However, there is a need for continued health education and support.
The results for breakfast consumption were inconclusive so it's not clear what changes
have been made to date.
All respondents reported eating fruit and vegetables though the variety for both was
limited.
Respondents were generally citing healthier food preparation and cooking methods such
as steaming and raw vegetable consumption though continued education is still
required.
There is a need for continued education and support regarding edible gardens as none
of the respondents cited their own production as a source of fruit and vegetables at 12
months.
Analysis of the blood results is inconclusive and needs to be considered in the separate
categories that are reported on. However, results do indicate that a number of
individuals in this community are at very high health risk.
Thirteen participants lost weight over the twelve month period. Despite these reductions,
three participants remained in the overweight range and fifteen in the obese range.
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Tongan Community Action Programme – Phase 2
1.2
Purpose
The purpose of the programme is to reduce health inequalities of Tongan people living in
Christchurch. The objectives are to reduce obesity and associated long-term health problems
by:
 improving nutrition,
 increasing physical activity levels and
 reducing the levels of smoking among the participants
As the TCAP2 has progressed it has become apparent that significant impact is occurring as a
result of the intervention. The PAG have identified three clear and intersecting areas where this
impact is occurring. They are illustrated in Figure 1 below.
Figure 1.2
TCAP Impact
Community
Development
Physiological
changes
Lifestyle
modification
The project is community-based and also aims to develop capacity within the community to
ensure sustainability and less reliance on external support. A community workforce
development focus continues.
The TCAP2 programme intervention is being coordinated and facilitated by two members of the
Christchurch Tongan Community Association. Havili Fifita and Tokanga Vehikite are both
graduates of the Certificate in Pacific Nutrition (CPN) programme (2006).
Havili and Tokanga are fluent speakers of English and Tongan and were contracted to the
National Heart Foundation during 2007. Tokanga continues her role as a Community Health
worker along with Ifalame Teisi. Ifalame graduated from the CPN programme in 2007. They
have been joined recently by Marcellino Taulango who is a qualified personal trainer.
Chris Mene has retained the role of Principal investigator for the research component of the
project and plays a mentoring role for Tokanga, Ifalame and Marcellino.
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Tongan Community Action Programme – Phase 2
1.3
Objectives
The objectives for the TCAP2 were initially identified through research and consultative means.
The research component identified previous projects that had attempted to engage with Pacific
peoples in New Zealand and selected the Healthy Lifestyle Pasifika (HeLP) promotion to model
the TCAP2 intervention on. The HeLP activity was run in the Wellington region for Pacific
people during 2002-2004.
An evaluation of this Wellington programme found it to be successful in increasing knowledge
and awareness of the participants about healthy nutrition and physical activity. Reasons for this
success were in part attributed to the community-based setting, Pacific ethnic specific resources
and Pacific Health workers with ethnic-specific language skills. One recommendation was that
programmes should be delivered within the context of the Pacific family group.
The development of the TCAP programme and the underlying health promotion theories are
comprehensively outlined by Duncan Edwards (Pacific Community Action Project: Formative
and Process Evaluation. February 2006 unpublished)
Consultation with mandated Pasifika and Tongan representation endorsed the development of
the TCAP2 objectives including the Christchurch Tongan Community Association executive and
Christchurch Pacific Community Reference Group. This consultative process was identified as
critical in order for the Tongan community to take ownership of the project and improve the level
of sustainability that could be achieved once the intervention ceased.
Ethics approval for the evaluation of the programme was sought and obtained by the Southern
Regional Ethics Committee prior to commencement.
A range of objectives were eventually identified and these appear in the TCAP2 Project Logic
Model (over page).
1.4
Methodology
The TCAP2 is a community action intervention supported by a process evaluation. The TCAP2
logic model (page 8) illustrates how the Research and development, programme activities and
outcomes relate to each other.
The development of the TCAP concept and consultation with stakeholders occurred first.
Through this consultation process programme activities were identified by the project
management team as was the value of a robust evaluation process.
Intervention
The Community Action Intervention (Second column on Project Logic) consisted of a series of
nine types of activities. The activities were:
1.
2.
3.
4.
Knowledge and awareness of smoking on health*,
Physical activity sessions*
Delivery of Key Health messages*
Healthy shared breakfasts*
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Tongan Community Action Programme – Phase 2
5.
6.
7.
8.
9.
Healthy food demonstrations*
School holiday programmes
Establishment of edible gardens in homes and community venues
Workforce development
Research feedback to individual participants by their General Practitioners.
The first five activities (*) were implemented during the first three months of the intervention.
The last four activities were implemented over a longer period and developed in a process of
ongoing consultation with the Tongan participants and their community association.
The initial community action approach described the responsive approach that the project would
take. The intervention has adapted to respond best to this particular community. For example,
participation at certain events has been impacted due to:
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Bereavements,
Church, sporting and cultural commitments,
Financial difficulties within the host community group
The initial three month intervention (October to December 2006) of the TCAP2 programme
consisted of 30 planned sessions:
●
●
●
14 Physical Activity sessions,
9 Shared Breakfast gatherings and
7 lunch food demonstrations.
More detail on these 30 sessions, the venues used and participant withdrawals are contained in
the previous PMR. Over the three month period another participant died as a result of cancer.
This reduced the number of participants expected for the fifth and final testing in April 2008 to
34.
All four individuals living in Christchurch who had withdrawn from TCAP continue to be invited to
programme initiatives. After the 18 month data and information is collected, collated and
analysed a request will be made to these four participants for an interview to explore further
what barriers continue to prevent them from participating (ie motivation, transportation, lifestyle
choices) and what support the project could provide to assist them.
Intervention Evaluation
Members of the Christchurch Tongan Community were informed of the project and invited to
participate. The evaluation component consisted of collecting clinical and action research data.
In addition observations and narratives were recorded.
Detail on the consent, clinical data, action research data and the documenting of activities can
be found in the previous PMR. Documentation of the activities of the TCAP2 continues to be a
dynamic and ongoing process.
The process evaluation included documenting activities allowing for a more robust outcome
evaluation that documents the characteristics of the project so that, if it is successful, it can be
replicated elsewhere.
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Tongan Community Action Programme – Phase 2
There is potential significance of this project for the advancement of knowledge as Pacific
people living in New Zealand are at higher risk of cardiovascular disease and diabetes than the
total New Zealand population. Programmes to promote lifestyle interventions such as smoking
cessation, healthy eating and physical activity in New Zealand are rare. They have been shown
to reduce obesity and other cardiovascular risk factors in other populations.
This is the first time such a programme has been used for a specific Pacific population in New
Zealand. It is hoped that the positive outcomes and learnings for the Christchurch Tongan
community will benefit other Pacific populations in Aotearoa New Zealand.
Figure X (over page) provides a visual representation of the evaluation component of the
TCAP2 and has the three impact areas relate to each other.
Figure 1.4
TCAP Impact evaluation
through clinical and
action research
Action
Research Data
Community
Development
Physiological
changes
Lifestyle
modification
Clinical
Research Data
Ethics approval for the evaluation of the programme was obtained from the Southern Regional
Ethics Committee prior to commencement of TCAP2. This approval extends for the period 20
September 2006 to 30 September 2008.
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Tongan Community Action Programme – Phase 2
1.5
Tongan Community Action Project Logic Model
Research &
Development
Activities
Development of TCAP
concept / consultation
with stakeholders
Programme
Activities
Knowledge and
awareness of
smoking on health
Short Term
Outcomes
(Up to 1 year)
Improved blood
pressure / bloods
Intermediate
Term Outcomes
(1-3 years)
Long Term
Outcomes
(3-5 years)
 Health of
Tongan
community in
Christchurch
 Rates smoking
cessation
Weight reduction
Formative
evaluation
Baseline, 3, 6, 12,
18 month data
outcomes &
sustainability
evaluations
Biomedical
measurements
N&PA data
questionnaire
Lifestyle activity
survey
TCAP Qualitative
survey
Physical activity
sessions
 Awareness of key
messages in HEHA
Key health
messages
 Participation in
physical activities
Healthy shared
breakfasts
 Awareness of the
importance of
breakfast
Healthy food
demonstrations
 Intake milk, fruit
& vegetables
School holiday
programmes
 Knowledge of
food preparation
and cooking skills
Edible gardens
Workforce
development
Research
feedback
Key:
 Contact with
General Practices
 Levels regular
physical activity
 Accessibility to
and affordability of
low FSS food
 Healthy meals
made at home
Sustained
change
 Commitment to
Healthy lifestyles by
Tongan families
 Capability to
grow vegetables &
fruit in own garden
 Commitment to
healthy lifestyles by
Tongan community
leadership
 Capacity Tongan
community
workforce
 Capacity Tongan
community
workforce
Biomedical
outcomes
Reduced health
inequalities
Lifestyle intervention
outcomes
 Community
connectedness
Community development
outcomes
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Tongan Community Action Programme – Phase 2
1.6
Current situation
The previous Project Monitoring report (PMR) contained an outline of the current situation for
Pacific peoples including the Tongan community. Information provided included a breakdown of
socio-economic and demographic data by Pacific ethnic group, age and location.
Information highlighting the Tongan peoples place in New Zealand is provided by Statistics New
Zealand. In 2006 Tongan people in New Zealand:
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Were the third largest Pacific ethnic group living in New Zealand, comprising 50,481
or 19 percent of New Zealand’s Pacific population (265,974)
Had a population increase by 9,762 or 24 percent between 2001 and 2006.
Had a median age of 19 years compared to 35 years for the total New Zealand
population
41 percent of the total Tongan population in New Zealand is New Zealand born.
40 percent of the total Tongan population was born in Tonga.
In Christchurch, the Tongan community represents approximately 11 percent of the total
Christchurch Pacific population (9,465) with 1,071 occupants in the city. The Tongan population
has a young demographic which reinforces the importance of proactive health responsiveness.
The Tongan population has a low median income which highlights a significant financial barrier
and some of the challenges this community has in maintaining and changing their lifestyles.
The Ministry of Health (2008) reports Pacific people are more likely to be in lower income bands
and less likely to be in higher income bands. Pacific people are over represented in the most
deprived areas; 42% of Pacific people live in NZ Deprivation 10 areas (would expect 10%) (MoH
2005). The age distribution of people living in the households of participants in the TCAP
indicates that some families had extended family members living with them.
This was confirmed by the project facilitator and is consistent with evidence indicating that
Pacific people are much more likely to be living as part of an extended family, eg grandparents,
parents and children or siblings living together than the total New Zealand population (Koloto
2007; MoH 2008).
High needs communities on low incomes have less access to healthy food. Every opportunity
should be made for appropriate messages regarding cheap, healthy food options. These health
messages were provided at the beginning of the programme followed by cooking demonstration
sessions at Rowley community House in April 2008. Budgeting needs to be an integral part of
menu planning.
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Tongan Community Action Programme – Phase 2
Part Two – Activities and Outcomes
2.1
Knowledge and awareness of smoking on health
Knowledge and awareness of smoking on health was identified as a programme activity as
smoking is a well known contributor to elevated blood pressure and cardiovascular disease.
Two programme participants admit to smoking cigarettes regularly.
Blood Results
The participants’ lipid profiles were recorded and some also had their glycated haemoglobin and
serum glucose recorded. All results were forwarded to the participants’ doctors and were
interpreted in strict accordance with the prescribed limits.
Thirty three individuals had blood sampled at one or more of the five waves of data collection.
However, only seventeen had blood sampled four or five times resulting in an incomplete data
set. This means it is not possible to accurately identify trends across this group or to use
percentages. Therefore, the number of participants for whom data was collected is stated for
each test.
Thirty two individuals participated in the 18 month wave of data collection. Of these thirty two,
one had blood sampling only, that is, no blood pressure and weight were recorded, while four
individuals had only their blood pressure and weight recorded but did not have blood sampled.
Glycated haemoglobin
Glycated haemoglobin (Gly Hae%) is formed when excess blood sugar binds to haemoglobin. It
gives an indication of blood sugar control over the previous weeks. Glycated haemoglobin was
not recorded for all participants, or at each point of data collection.

28 participants had their glycated haemoglobin recorded at one or more points of data
collection. Of these 14 were within the normal range and 14 were elevated
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The highest glycated haemoglobin (13.5) was recorded at baseline and was taken from
a woman who was known to be a diabetic. Since the baseline wave of data collection
her glycated haemoglobin has been lower each time it was recorded. Although still high
at the 18 month wave of data collection it had reduced to 9.1.
SerumGlucose
The normal range for serum (blood) glucose is 3.5-5.5. Serum glucose was not recorded for all
participants or at each point of data collection. Fasting blood glucose is the recommended test
to determine if an individual has diabetes and a fasting blood glucose equal to or over 7mmol/L
indicates that an individual has diabetes (Diabetes New Zealand; WHO 1999). A fasting blood
glucose level between 6.1mmol/L and 6.9mmol/L is diagnostic of impaired fasting glycaemia
(IFG) or pre-diabetes.
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Tongan Community Action Programme – Phase 2
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29 participants had their serum glucose recorded at 18 months; of these 13 were within
the normal range and 17 were elevated

Of these 17 participants, ten* had fasting blood glucose levels above 7mmol/L indicating
they may be diabetic. Eight of these recorded fasting blood glucose levels above
7mmol/L on two or more points of data collection. Another two had fasting blood glucose
levels between 6.1mmol/L and 6.9mmol/L indicating IGF.
* One of the ten is a known diabetic.
The continued elevated glycated haemoglobin and serum glucose levels reported in this
group of people is consistent with a MoHa (2008) report that 33 percent of the Tongan
participants in a study had exceptionally poor control of their diabetes compared to 6
percent of the European participants. The study found differences in the perceptions of
diabetes between Tongan and European participants. The Tongan participants tended to
view their diabetes as a cyclical, acute illness and were characterised by lower
adherence to dietary and medication recommendations. This contrasted with European
participants who considered it to be a long term condition. Tongan participants were
more likely to attribute their illness to external factors, were more emotionally distressed
by their diabetes had less confidence in their ability to control their and saw less
necessity for diabetes medication.
Lipid Profile
According to the National Heart Foundation (2005) the normal range for a lipid profile is:
Total cholesterol (TC)
<4 mmol/L
Triglycerides
<1.7
High density lipoprotein (HDL)
>1 mmol/L
Low density lipoprotein (LDL)
<2.5 mmol/L
TC/HDL ratio
<4.5
One participant had a normal lipid screen at both baseline and the 18 wave of data collection,
while one was abnormal at baseline and came into the normal range at 18 months and
conversely one participant had a normal lipid screen at baseline that was abnormal a 18
months.
Total Cholesterol (<4mmol/L)
The following results relate to 25 participants. Twenty-seven participants had their lipids
screened at baseline and 18 months, however, the results of two participants are not included
as they were pregnant which may have altered their lipid profile.

At baseline the median total cholesterol was 5.0 (range 3.5 to 6.9). The mean was 5.1

At 18 months the median total cholesterol was 5.0 (range 2.7 to 7.3). The median was
4.9

2 participants had total cholesterol levels within the normal range at baseline

4 participants had total cholesterol levels within the normal range at 18 months
Page 17 of 87
Tongan Community Action Programme – Phase 2
Triglycerides (<1.7)
 At baseline the median triglyceride was 1.5 (range 0.5 to 3.2). The mean was 1.5
 At 18 months the median triglyceride was 1.3 (range 0.6 to 2.6). The median was 1.5
 17 participants had triglyceride levels that were within the normal range at baseline
 14 participants had triglyceride levels that were within the normal range at 18 months
High density lipoprotein (HDL)
 At baseline the median HDL was 1.3 (range 1.0 to 2.1). The mean was 1.4
 At 18 months the median HDL was 1.2 (range 0.9 to 1.7). The mean was 1.2
 24 of the 25 participants had HDL levels within the normal range at baseline
 21 of the 25 participants had HDL levels within the normal range at 18 months
Low density lipoprotein (LDL) (<2.5mmol/L)
The laboratory analysing the blood samples gives <3.4 as the preferred value compared with
the Heart Foundation’s value of <2.5. A laboratory technologist was not sure why the values
differ. For this report the Heart Foundation limit was applied, therefore <2.5 mmol/L is
considered to be the normal limit for a low density lipoprotein.
 At baseline the median LDL was 3.2 (range 1.4 to 4.9). The mean was 3.0
 At 18 months the median LDL was 3.0 (range 0.9 to 4.8). The mean was 3.0
 7 participants had LDL levels within the normal range at baseline
 7 participants had LDL levels within the normal range at 18 months (four participants had
normal LDLs at both data collection points).
 19 (of 26) participants had elevated LDL levels at 18 months
TC/HDL ratio (<4.5)
 At baseline the median TC/HDL ratio was 3.6 (range 1.8 to 4.9). The mean was 4.0
 At 18 months the median TC/HDL ratio was 3.8 (range 2.1 to 5.3). The mean was 4.0
 13 participants had normal TC/HDL ratios recorded at both baseline and 18 months
 3 participants had TC/HDL ratios that went from being elevated at baseline to within the
normal range to at 18 months.
 5 participants had TC/HDL ratios that went from within the normal range at baseline to
being elevated at 18 months.
Page 18 of 87
Tongan Community Action Programme – Phase 2
Total Cholesterol/High Density Lipoprotein cholesterol (TC/HDL) ratios
 13 out of 25 participants had TC/HDL ratios at baseline and at 18 months
 3 had improved TC/HDL ratios showing lowered CV risk
 3 participants had TC/HDL ratios that went from being elevated at baseline to within
the normal range to at 18 months.
 5 participants had TC/HDL ratios that went from within the normal range at baseline
to being elevated at 18 months.
The MoH (2005 pg.26) reported that 48% of households with dependant Pacific children
can afford to eat properly only sometimes compared with the national average of 20 %.
These results show some improved blood results and identify some high risk participants. It
is useful to consider that for some participants their cultural views, language and history
may lead them to a different worldview of health which may influence the way “they
perceive, access and use health service and (sic) can influence the outcomes of
interventions” (MoH a2008 pg.17).
The MoH a (2008 pg.17) quotes Tukitonga stating that “in general, Pacific culture and
beliefs about health and illness are different from those of mainstream New Zealand; as
health is considered to be a holistic notion and a family concern rather than an individual
matter”. Many of the participants remain at high risk for CV disease and other obesity
related conditions.






The proportion of the 26 participants with a BMI higher than 40kg/m2 fell from 30% to
15% by 18 months
19 out of 29 participants had TC/HDL ratios <4.5 at 18 months
14 out of 28 participants had glycated haemoglobin <6% (non-diabetic)
17 out of 26 participants had triglyceride levels <1.7mmol/l
21 out of 25 participants had HDL levels >1mmol/l
7 of the 26 participants had normal LDL levels <2.5mmol/l
Identification of high risk participants:
 14 out of 28 had glycated haemoglobin >8% indicating an increased risk of diabetes
 17 out of 29 had serum glucose (>6mmol/l) indicating an increased risk of diabetes
 21 out of 25 had elevated total cholesterols (>8mmol/l) indicating an increased risk of
heart disease
 19 out of 26 had LDL >2.5mmol/l, indicating an increased risk of heart disease
 21 out of 26 participants were obese (BMI >30kg/m2)
Intermediate term outcomes (1-3 years)

Increased rates of smoking cessation
There were two questions related to intention to stop smoking. These questions were intended
to be completed only by participants who smoke.
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Tongan Community Action Programme – Phase 2
The first question asked individuals to respond to one of three options about their intention (or
not) to quit. Participants were then asked to respond to a ‘stages of change’ question, again
regarding their intention to quit. These questions are designed to be completed by participants
who smoke and to be passed over by non-smokers. Therefore, as there were only two
participants identified as smokers there should have been only two responses, however, the first
question was completed by 14 participants and the second question by 12. The numbers
answering this question varied at each wave of data collection and was reduced to four at 18
months.
As there was not a question regarding participants’ current smoking status it is not possible to
accurately identify the number of smokers. However, according to the project facilitator two
participants (5%) identified as smokers at the initial wave of data collection. This low number of
reported smokers is in contrast with the MoH (2005) that reports that 34.6 % of Pacific males
aged over 15 years smoke and 28.5% of Pacific females aged over 15 years smoke. The MoHb
(2008) reports the prevalence of smoking in Pacific people aged over 15 years as 26.9%.
Three possible interpretations of this are; that participants did not understand the question and
replied that they had ‘no intention of quitting smoking’ because they do not smoke and therefore
had no thought of quitting, secondly, they gave a socially acceptable answer due to the publicity
of smokefree messages and thirdly, there were actually more smokers than were identified.
●
Blood Pressure
According to the National Heart Foundation (2005) an ideal blood pressure (BP) is less than
130/80. The data was analysed according to these limits. High blood pressure
(hypertension) is defined as the systolic (top) number being greater than 140mm Hg and the
diastolic (lower) number being greater than 95 mm Hg on repeated readings (National Heart
Foundation). The systolic, diastolic or both may be high.
Twenty seven participants had their blood pressure recorded at baseline and 18 months.

At baseline the median systolic blood pressures of these 27 participants was 130
mm Hg (range 104 mm Hg to 180 mm Hg). The mean was 130 mm Hg.

At 18 months the median systolic blood pressure was 130 mm Hg (range 100
mm Hg to 198 mm Hg. The mean was137 mm Hg.

At baseline the median diastolic blood pressure of these 27 participants was 81
mm Hg (range 65 mm Hg to 100 mm Hg). The mean was 80 mm Hg.

At 18 months the median diastolic blood pressure was 80mm Hg (range 60 mm
Hg to 115 mm Hg). The mean was 85 mm Hg.
The median blood pressure at baseline was 130/81 and 130/80 at 18 months.
2.2
Physical activity sessions
Physical Activity sessions were provided throughout the 18 month intervention. A more
complete schedule of physical activity support is outlined in the methodology (page 9). Physical
activity helps to improve blood pressure and weight reduction.
Intermediate term (1-3 years)
Page 20 of 87
Tongan Community Action Programme – Phase 2

Weight reduction at 18 months
Body Mass Index
The body mass index (BMI) calculates the ratio between an individual’s height and weight
giving an indication of body fat and the associated risk of morbidity. It is not useful for some
individuals as the BMI cannot distinguish between lean muscle mass and fat mass and
therefore, may overestimate body fat in athletes, certain ethnicities and those with higher
amounts of muscle. Conversely, BMIs may also underestimate body fat in the elderly
population. However, the BMI is useful for estimating the proportion of a population who
have an increased risk of health conditions associated with obesity (MoH b 2008). The
World Health Organisation (WHO) lists 17 conditions associated with obesity.
Twenty-nine participants had their height and weight recorded at 18 months and one or
more other points of data collection (not necessarily baseline). However, only 26 are listed in
the table below as two participants were pregnant and one had recently given birth at the
time of the 18 month data collection.
The individual body weights in the following table are consistent with the Ministry of Health
(2005 pg.28) statement that “Pacific Peoples are not significantly more likely to be
overweight than the national average but are approximately twice as likely to be obese
despite using a higher cut off for the overweight and obesity categories”. The MoHa (2008
pg.18) also reports “that overweight and obesity were uncommon in traditional Pacific
communities and up until the 1960s were rarely noted”. The MoHa (2008) reported on a
study finding that Tongan men consistently chose larger body sizes for both females and
males as being more attractive. The “attractive body size” for men corresponded
approximately to a BMI of 30.
The Ministry of Health (2005) classifies BMIs in the following way:
For the total population: overweight = ≥ 25.0 - <30.0
obese
= ≥30.0
For Pacific peoples:
overweight = ≥26.0 - < 32.0
obese
= ≥ 32.0
According to the MoH b (2008) the mean BMI for Pacific adults is 33.2, which is lower than
the mean BMIs of participants at both baseline and 18 months.

At baseline the median weight of the 26 participants was 104.5 kilograms (kg),
(range 70 kg to 200 kg). The mean was 109 kg.

At 18 months the median weight of the 26 participants was was 111 kg (range 78 kg
to 205 kg). The mean 104.5 kg.

At baseline the median BMI of the participants was 36 (range 24.2 to 66.8). The
mean was 37.7

At 18 months the median BMI of the participants was 35.3 (range 27 to 68.5). The
mean was 37.2
Page 21 of 87
Tongan Community Action Programme – Phase 2
Table 1. The Body Mass Index of Participants
Height
(m)
1.70
1.73
1.80
1.69
1.61
1.67
1.58
1.68
1.80
1.61
1.61
1.67
1.71
1.66
1.67
1.63
1.85
1.70
1.80
1.65
1.64
1.70
1.81
1.77
1.73
1.75
Baseline
Weight
(kg)
77
89
98
85
85
91
84
99
117
97
93
117
118
122
112
110
138
127
114
139
98
70
113
101
200
148
Baseline
BMI
18 month
weight
26.6
29.7
30.2
29.8
32.8
32.6
33.6
35.1
36.1
37.4
35.9
42
40.4
44.3
40.2
41.4
40.3
43.9
35.2
51.1
36.4
24.2
34.5
32.2
66.8
48.3
78
30
93
85
81
89
80
91
109
92
92
104
111
111
112
105
136
126
110
135
100
98
115
106
205
158
18
month
BMI
27
29.1
28.7
29.8
31.2
31.9
32
32.2
33.6
35.5
35.5
37.3
38
40.3
40.2
39.5
39.7
43.6
34
49.6
37.2
33.9
35.1
33.8
68.5
51.6
At baseline (of the 26 participants listed):

1 participant had a BMI in the normal range

4 participants had BMIs in the overweight range

21 participants had BMIs in the obese range
At 18 months (of the 26 participants listed):

There were no BMIs in the normal range

5 participants had BMIs in the overweight range
Page 22 of 87
Tongan Community Action Programme – Phase 2

21 participants had BMIs in the obese range

1 participant’s BMI had moved down from the obese range to the overweight range

1 participant gained 28 kg, raising her BMI from the normal range to obese.
Figure 1: The BMIs of 26 participants at baseline and 18 months grouped into specific BMI
ranges.
Percentage of
participants
BMIs of 26 participants at baseline and
18 months
70
60
50
40
30
20
10
0
Baseline
18 Months
20
30
40
50
60
BMI
y
As the figure shows the proportion of participants with BMIs in the 20s, 50s and 60s
remained the same at baseline and 18 months. However, the proportion of participants
whose BMIs were in the 40s fell from 30% to 15% at 18 months.
At 18 months, 18 participants had lost a total of 90 kgs. The median individual weight
loss was four kilograms (range one to 13 kgs). The mean was five kilograms. Two
individuals recorded the same weight at baseline and 18 months. Six participants
gained a total of 52 kilograms. The median individual weight gain was five kgs (range
two to 28 kgs). The mean was seven kilograms.
●
Increased rates of smoking cessation
Refer to page 20.
●
Increased contact with General Practices
Participants were asked the question “When was the last time family saw GP/Dr?” during
the baseline and 18 month data collection. Thirteen participants completed the
questionnaire at baseline and 18 months.
Page 23 of 87
Tongan Community Action Programme – Phase 2
All thirteen participants who completed questionnaires at both baseline and the 18
month wave of data collection indicated that they had visited a doctor within the last
year. Some listed specific dates. Two participants did not respond at baseline and one
did not at 18 months.
A survey was conducted in February and March 2008 with the GPs responsible for the
18 participants who had biological (Blood pressure, Fasting Glucose and/or Lipids)
outside of the normal range. The survey sought evidence of sustainability by obtaining
feedback on their perspective of whether the short and medium term objectives were
being achieved by their clients as participants in the TCAP intervention. GPs responded
that they had increased contact with 10 out of 16 participants in the TCAP intervention.
GPs did not have increased contact with four of the 16.
This was also considered to be a tool for gauging prospective levels of sustainability with
respect to general practice in relation to the short and medium term objectives of the
TCAP programme. Three GPs were identified for meeting to interview. Two of the three
GPs agreed to meet and discuss the project and feedback through the survey with the
Tongan community worker. The third was not accessed as the receptionist indicated he
was very busy. This GP had two clients participating in the project who have been a
challenge to keep engaged in the project. No data was received by the GP for these two
participants leaving a total number of 16.
The following are the short term (up to 1 year) and intermediate term (1-3 years)
outcomes that we have aimed to achieve. GPs were asked to indicate beside each
outcome their perspective of each outcome with respect to each client. The outcomes
are numbered 1-11 and GPs indicated whether they agreed, were unsure or disagreed
with the outcome. Note that some questions were not answered.
The results are positive showing agreement by GPs that the project is having a positive
effect on the majority of the participants considered ‘higher risk’ towards the short and
medium term outcomes of the project.
Table 2 (over page) provides the tabulated results from GPs for 16 of the 18 participants
who have been identified as having blood results outside of the normal range. One of the
more significant statistics is that GPs indicated 10/16 participants have had increased
contact with their GPs as a result of the TCAP programme. GPs were unsure about 2/16
and disagreed about 4/16. Remedial action will be considered for the 6 participants
where GPs were unsure and disagreed.
Of the five short term outcomes GPs indicated disagreement on only two occasions across
two of the five outcomes. There appears to be indicative agreement by GPs that participants
were achieving the short and intermediate term outcomes of the TCAP project.
Other comment from GPs included:

Learned about food preparation and has increased physical activity

Information about food and food preparation

Short conversations only. He seemed quite motivated at the time

Ongoing contact to help support and keep him motivated
Page 24 of 87
Tongan Community Action Programme – Phase 2
Ongoing contact to motivate

Nothing I can think of. We have a recall system in place
Motivated
Unsure
1
12
4
9
11
6
5
11
4
11
4
1
Intermediate term
6. Increased rate(s) of smoking cessation
1
7
2
7.
Increased contact with General Practices
10
2
4
8.
Increased levels of regular physical activity
9
6
1
8
7
10
9
5
6
Short term
1. Increased awareness of key messages in
HEHA
2. Increased participation in physical activities
3. Increased awareness of the importance of
breakfast
4. Increased intake milk, fruit & vegetables
5.
Increased knowledge of food preparation
and cooking skills
9.
Increased accessibility to low fat, sugar and
salty foods
10. Increase in healthy meals made at home
11. Increased commitment to Healthy lifestyles
by Tongan families
●
Comments
Agree
Table 2 - Collated results
Disagree

Needs encouragement from work colleagues
to have healthy options
Needs encouragement from work colleagues
to have healthy options
Wife prepares food
Help keep family healthy
Continues to smoke 20/week
Stopped smoking in 2003
2x Not applicable
2x Assisted by Careplus
Often limited by lack of an interpreter
Last seen in 2006
2x Uses free diabetes review annually
Very proactive with health
Not seen for 12 months
Depends on family
Regular with medicines
2x Not seen since arriving to NZ from Australia
Some lack of motivation although aware of
benefits
Aware although finding this difficult
General Practitioners Survey follow up
The second survey was conducted with the general practitioners of those participants who
had one or more recorded blood and blood pressure results outside of the normal range.
This was done face to face and by mail out. The results are positive showing agreement by
GPs that the project is having a positive effect on the majority of the participants considered
‘higher risk’ towards the short and medium term outcomes of the project. (Refer to detailed
results on pages 12-13)
Page 25 of 87
Tongan Community Action Programme – Phase 2
2.3 Awareness of Key Messages in HEHA
The consistently high cholesterol results of the participants indicated a closer look at the
saturated fat foods influencing cholesterol levels.
Short term (up to one year)
●
Pantry Project
The ‘Pantry Project’ assessed the extent to which high saturated fat foods are still a part of
participants’ diets. This project relates to three short and intermediate term project outcomes
which were:
1) Increased awareness of key messages in HEHA (0-12 months)
2) Increased knowledge of food preparation and cooking skills (0-12 months)
3) Increased healthy meals made at home (1-3 years)
The results show that high saturated fat foods still form a significant part of the participants’
diet. Positive changes have occurred in the frequency of consumption of some foods
however, a significant number of participants mentioned eating high saturated fatty foods
once/twice or three to five times a week.
Introduction
Discussions regarding food and dietary practices that influence blood cholesterol were
conducted with 15 participants over the phone. The following section is a summary report of
food consumption and dietary practices as outlined below.
Food consumption
Participants were asked to discuss how often they eat certain foods and the following
information was obtained.
Food types:

Cream/ coconut cream
One third (5/15) of the participants have creams or coconut cream once or twice per
week and the rest (10/15) less than once a week.

Ice-cream
About three quarters (11/15) of the participants ate ice-cream less than once a week
while the rest had it once or twice a week (2/15) or three to five times a week (2/15.)

Cheese
Though three in every five (9/15) participants ate cheese less than once a week or
never, one in five (3/15) still consumed it three to fives per week.

Eggs
All participants reported eating three eggs a week or less.
Page 26 of 87
Tongan Community Action Programme – Phase 2

Milk type
Three in every five (9/15) participants reported using trim (green top) or low fat (light
blue top) milk. However, a significant two in five (6/15) use homogenised blue top
milk.

Skin on chicken
Just under half (7/15) the participants reported eating some, most or all of the skin on
chicken; the rest said they ate none of it.

Fat on meat
Two in every three (10/15) participants reported having some, most or all the fat on
meat while the rest said none.

Deep fried food in batter
Four in every five participants (12/15) reported having deep fried food in batter less
than once a week and the rest (3/15) had once or twice a week.

Sausages, meat pies, sausage rolls, luncheon sausages, tinned corn beef,
bacon or mutton flaps.
Two in every three (10/15) participants had the above mentioned meat once/twice or
three to five times a week. Only one in three (5/15) ate these less than once a week.

Hot chips or fries
The majority of participants (9/15) reported eating chips or fries less than once a
week. Only one in five (3/15) had them once or twice a week. The remaining 3/15
said they never ate chips.

Gravy, cream or cheese sauces
All 15 participants said they ate the above foods once or twice a week or less.

Sweet pies, pastries, cakes, muffins or croissants
Four in every five (12/15) of the participants ate the above foods less than once a
week or never. The rest (3/15) had them once or twice a week.

Chocolate, chocolate bars and chocolate biscuits
Almost all (13/15) participants said they ate the above foods less than once a week
or never.
Dietary Practices

Addition of butter, margarine, oil or sour cream to vegetables, cooked rice,
pasta or noodles
Four in every five (12/15) participants reported adding the above fats/ oil to food
three to five times a week or more. The rest (3/15) said less than once a week or
never

Spreading butter/margarine on bread
All 15 participants reported using margarine instead of butter on bread. However,
almost half (7/15) said they used medium to thick spread.
Page 27 of 87
Tongan Community Action Programme – Phase 2
Discussion
The above results show that high saturated fat foods still form a significant part of the
participants’ diet. Positive changes have occurred in the frequency of consumption of
ice-cream, deep fried food in batter, hot chips/ fries, gravy, cream or cheese sauces,
chocolate, coconut cream, cheese, sweet pies, pastries, cakes, muffins or croissants.
However, a significant number of participants mentioned eating sausages, meat pies,
sausage rolls, luncheon sausages, tinned corn beef, bacon or mutton flaps once/twice or
three to five times a week. Most also said they had some, most or all the fat on meat or
skin on chicken. As meat plays an important role in the Tongan diet, there is a need to
emphasize the importance of removing fat and skin off meat and chicken as well as
suggesting less fatty options.
Additionally, most participants still added oil, margarine or sour cream to food and also
put medium to thick spread on bread. These practices increase the consumption of
saturated fat, hence raising cholesterol levels. There is a need to review the abovementioned food choices and eating habits in order to make a significant reduction in
cholesterol levels.
An appropriate resource for the nutrition educator will be produced to address some of
the above issues.
●
Increased levels of regular physical activities
Tongan Group Exercise
Tongan Group Exercise was introduced during the initial TCAP2 intervention. Participants
attended a local circuit gym up to three times a week over a ten week period (OctoberDecember 2006). Although this was proving to be an effective and highly attended sessions
it was acknowledged that this would not be sustainable for many Tongan community
members. Reasons given included:





Cost (Even with a community services card)
Childcare costs
Access/Transport
Self confidence
Language barriers
As a result of this the Tongan community were supported in 2007 to develop there own
exercise circuit sessions. The NHF supplied a range of exercise equipment and provided
support for a Tongan fitness instructor to take these classes.
Exercises classes continue to attract small but consistent numbers of participants and have
been delivered at a local community facility up to 30 June 2008. Tongan community and
local community leaders have been connected with local government and health staff to
identify ongoing funding and resource support for group exercise.
Reasons given for attending include:

No cost
Page 28 of 87
Tongan Community Action Programme – Phase 2




Children can join in or play nearby with sports equipment
Accessible location
Its fun exercising with friends and family
Happy to speak in English or Tongan
Intermediate term (1-3 years)
●
Increased levels of regular physical activity
This section covers physical activity data collected from the sixteen participants who
completed most of the questions in the questionnaire at baseline and 18 months. Not all
questions were completed and where the number varies it is listed. The questions in this
section related to family behaviours rather than individual behaviours. It is assumed that this
was understood by the participants who then replied to questions on behalf of their family.
Any percentages given relate to the number of stated participants not the total number of
individuals in the project.
Normal modes(s) of travel
The question was “normal mode(s) of travel”.
16 participants completed this question at baseline and 18 months.
All participants listed cars as a method of travel at baseline and 18 months.
 50% (n=8) families indicated walking was a method of travel at baseline.
 56% (n=9) families indicated walking was a method of travel at 18 months.
This is an increase of one family at 18 months.
Favourite Family Physical Activities
The questions were “Family favourite physical activities” and “How often family do these
activities”.
10 participants completed this question at baseline and 18 months
The following activities were reported; playing the guitar, exercise, walking, rugby, touch
rugby, cycling, gardening, tennis, church, swimming, netball and gym.
 3 families reported an increase in the number of weekly physical activity sessions
 3 families reported the same level of weekly physical activity sessions
 4 families reported a decrease in the number of weekly physical activity sessions
At baseline there were 35 sessions of participation in physical activity reported in a week.
Averaged between the 10 households, this is 3.5 sessions of physical activity per week per
household. At 18 months there were 31 sessions of participation in physical activity
reported in a week, which averaged to 3 sessions per week per household. Overall this is a
slight decrease in the reported frequency of physical activity at 18 months.
Six of the 16 replies were invalid, for example, one participant listed a specific date rather
than a frequency, one reported daily guitar playing and one participant reported ‘am/pm’,
that is, the time of day they engaged in the activity rather than the frequency. Some
participants answered at either baseline or 18 months but not both. This left 10 people who
responded on behalf of their family at both baseline and 18 months to the question ‘family
favourite physical activities’ and ‘how often the family engages in these activities’ (sic).
Page 29 of 87
Tongan Community Action Programme – Phase 2
Family’s favourite sport or game
The questions were “Family’s favourite sport or game” and “How often the family plays these”.
Seven participants completed this question at baseline and 18 months
The same activities as above were listed with inclusion of volleyball.
 2 families reported an increase in the frequency that the sport or game was played
 5 families reported the same frequency of participation
For the following reasons it is not possible to accurately record the number of times families
engaged in their favourite sport or game; missing data and the lack of accurate frequencies, for
example, one participant reported playing rugby ‘very rarely’ at baseline and cycling daily at 18
months. This increase is not able to be quantified. Likewise, as mentioned previously one
participant gave a non-specific (but equal) frequency at both points of data collection. Of the five
participants who did list specific frequencies; 4.5 sessions of participation in sport or games
were reported in a week at baseline and 5.5 sessions of participation in sport or games were
reported in a week at 18 months.
Other potential reasons for both these questions not accurately capturing the frequency that
families engaged in physical activities, games or sports include seasonal variations, for
example, walking may reduce in frequency in winter. Also, differences in the activities listed may
have contributed to different frequencies being reported. For example, some families listed the
frequency of playing rugby as weekly and later the frequency of walking as daily. This was
recorded as an increase in frequency. However, when this data was reported in the opposite
order it was recorded as a decrease in frequency. Team activities such as rugby and league are
not accurately comparable with walking and cycling. It could be that families continued to walk
or cycle to work or school, but listed a team sport at a different point of data collection because
it coincided with enrolment or purchase of boots etc and was therefore foremost in their mind.
Some further questioning would have been useful to clarify this.
This question is reasonably similar to the previous one and it is suggested that some of the 16
participants who completed most of the questionnaire at baseline and 18 months were confused
by this question. This is shown by both their replies and the fact that nine responses were
invalid for reasons such as, listing rugby as the family’s favourite sport but reporting the
frequency of participation as ‘watching’ and non responses at either baseline or 18 months. One
of the 16 participants did not respond at all to this question. Another participant listed ‘once in a
while’ and ‘not very often’ as the frequency which they engaged in the activity. This was
considered to be valid and was recorded as the same frequency. This left seven participants
who completed the question at both baseline and 18 months.
Television viewing
The question was “On average how many hours a day is your TV on?”
12 participants completed the questionnaire at baseline and 18 months



4 families reported a decrease in the length of time the television was on
3 families reported the television was on for the same number of hours
5 families reported an increase the length of time the television was on
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Tongan Community Action Programme – Phase 2
At baseline the television was reported as being on for a total of 43.5 hours per day amongst 12
families, which is an average of 4 hours per day. At 18 months the television was reported as
being on for a total of 49 hours per day amongst 12 families, which is also an average of 4
hours per day.
The responses to this question may be unreliable due to several factors; (i) the number of hours
the television was on does not necessarily correlate to hours actually watched (the television
may have been going in the background and/or the total viewing time may have been shared
between family members), (ii) the response categories to this question were not mutually
exclusive, for example, does having the television on for two hours a day fit in 1-2 hours or 2-3
hours? (iii) the number of people living in some households was dynamic and these altered
household structures mean comparisons may not be accurate.
Number of people living in a house
The question was “How many people live in your house?”
Twelve participants completed this question at baseline and 18 months
 At baseline the number of people living together in a house ranged from three to nine
(median 6)
 at 18 months the number of people living together in a house ranged from three to
ten (median 6 )
 Two of the 12 participants reported the same number of people living in their house
at baseline and 18 months, seven reported fewer people living in their house and
three reported more people living in their house at 18 months than at baseline.
The age distribution of people living in the households indicates that some families had
extended family members living with them. This was confirmed by the project facilitator and is
consistent with evidence indicating that Pacific people are much more likely to be living as part
of an extended family than the total New Zealand population (Koloto 2008, MoH a 2008).

Stages of Change for physical activity levels
This section relates to the participants’ individual beliefs regarding physical
activity. The questions were framed using a ‘stages of change’ model. Stages of
change questionnaires are designed to assess an individual’s motivation and
readiness to either, adopt a health promoting behaviour, or change an addictive
behaviour; however, they were used here in a collective manner. It should also
be noted that a stated intention does not necessarily translate into behaviour
change.
Participants were asked whether they ‘strongly agreed’, ‘agreed’, (sic) were
‘undecided’, ‘disagreed’ or ‘strongly disagreed’ to twelve statements; some of
which are ambiguous. For example, when participants disagree with the
statement “I am satisfied being an inactive person”, do they mean they are
inactive and would like to be more active, or, do they mean that they are already
active and therefore this statement is not applicable to them?
Twenty nine participants completed this part of the questionnaire at the 18 month
wave of data collection. Participants indicated an awareness of the potential
consequences to their health of not being physically active.
In response to the statement, “I am afraid of the consequences to my health if I
do not exercise”
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Tongan Community Action Programme – Phase 2
o
o
at baseline 25 out of 31 participants either strongly agreed or agreed with
the statement
At 18 months 28 of 29 participants strongly agreed or agreed.
Responses to the statement, “I have been thinking about whether I will be able to
exercise regularly” indicated that more people were aware of the importance
physical activity.
o at baseline 19 out of 30 participants either strongly agreed or agreed with
the statement
o at 18 months 27 out of 29 participants either strongly agreed or agreed
In response to the statement, “I don’t exercise and right now I don’t care”
o at baseline 21 out of 32 participants strongly disagreed or disagreed with
the statement.
o at 18 months 23 out of 29 strongly disagreed or disagreed
Participants were asked to score three statements indicating that they were
already exercising or had begun to exercise:
“I have been exercising regularly for a long time and I plan to continue”,
“I am finally exercising now and I plan to continue”
“I have started to exercise regularly and I plan to continue”
o
16-20 (of 29) respondents strongly agreed or agreed with these
statements at 18 months
There is an identified need for continued health education and support.

Free Physical Activity sessions
From February to April 2008 the remaining 34 TCAP participants were invited to
attend physical activity circuit training at a local fitness centre. Classes were set
up and a Tongan group trainer contracted to instruct and guide members
attending the free sessions. The sessions were spread out over different days
and times of the week to give participants every opportunity to attend.
These sessions were established in response to a request from some of the
TCAP participants at in June 2007. This was done through a qualitative survey in
Tongan language. The following narrative comments had been received in
Tongan and then translated to English:








Increase time spending on exercise each week
Exercising, blood test
Help me to move those pains that haven’t been moved by other exercises
Learn about body and how to keep it well
Exercise for better health, eat healthy and socialize people
More frequent exercise classes / circuits at the Tongan centre
Keep to Saturday mornings or afternoons (work around children’s sport)
Greater co-ordination from within the Tongan Community to ensure better
turnout
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Tongan Community Action Programme – Phase 2


More exercise days in a week
To let messages reach little children and teenagers
Attendance at the free sessions over February and March 2008 ranged from 2-14
participants and the sessions continued through until the end of June.
April to June 2008
For the ten week period from April to June the physical activity programme
continued to provide a physical activity resource for the TCAP2 participants and
well as the Hoon Hay Community. Both these groups are based from the Rowley
Resource Centre in South Christchurch.
All sessions were run by Marcellino Taulango, a qualified personal and group
exercise trainer who was contracted by the Heart Foundation.
The venues used for the Physical Activity sessions included:
 Rowley Resource Centre, Hoon Hay
 The Active Room – Fitness Centre, Tower Junction
 Hoon Hay Park, Hoon Hay
 Hoon Hay Environs
There were 32 individuals who participated in the programme and between them
attended 198 times over the duration of the programme. Daily attendances
ranged from a low of zero to a high of twelve.
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Tongan Community Action Programme – Phase 2
2.4 Healthy Shared Breakfasts
Short term (up to one year)
●
Increased awareness of the importance of breakfast
Having breakfast is important to reduce weight and cholesterol. Participants may be
aware of this but definitely breakfast was not adopted as a daily habit. While it seems
porridge and breakfast cereal consumption has increased it appears that most
participants are only having breakfast some mornings.
Intermediate term (1-3 years)
●
Increased accessibility to and affordability of low fat, sugar and salt foods
According to respondents some positive changes have been made towards healthier
food choices.
Increased awareness about the importance reducing fat
Participants indicated an increased awareness about the importance of reducing the fat
content in food at the 18 month wave of data collection. In response to a question about
intended changes to the consumption of corned beef cooked in cream, bananas cooked
in coconut cream, lamb cooked in coconut cream and coconut dumpling,
o
o
17 out of 29 indicated they were trying to eat less of these foods at baseline
23 out of 29 indicated they were trying to eat less of these foods at 12 months
Sweet Foods
At least a third of the respondents were consuming one form of sweet food or other 1-4
times per week over the 5 data collection periods. Some of these e.g. muffins can be
effectively incorporated into a healthy, varied diet. Others such as cream-filled biscuits,
sweet pies and pasties, puddings and desserts are still being consumed 1-4 times per
week by about a third of respondents. These would contribute significantly to the fat and
sugar consumption of the participants.
Ongoing education is required regarding these foods. This should include recipe
modification, portion size, recommended number of servings and appropriate lower
sugar and/ or fat alternatives. Most households should be able to bake as they reported
having ovens in their homes. This would be especially appropriate to encourage home
baking and recipe modification to make these foods healthier.
Snacks
Additionally, households choosing healthy snacks such as crackers, fruits and
vegetables did not change much or remained relatively low over the 18 months period.
At the same time, chips, chocolates, biscuits and cakes still featured as snacks of choice
over the same period.
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Tongan Community Action Programme – Phase 2
Though number of respondents citing these may be considerably low, its possible that
actual numbers are higher but participants under-reported due to familiarity with ongoing nutrition education messages. This community could benefit from on-going
support to allow gradual acceptance and adoption of healthier food choices.
Respondents were asked how often they ate selected sweet foods and soups.
Fifteen of the 31 respondents (48.4%) said they ate the following foods 1-4 times per
week , with the rest having them less than once a month or never at 18 months:
o
o
cakes, scones or pikelets
muffins-all types
An average of one in every three respondents reported consuming the following sweet
foods 1-4 times per week while the rest had these less than once a month or never for
the five data collection periods.
o
o
o
sweet pies or pasties
cream-filled or chocolate biscuits
other puddings or dessert (not including milk desserts)
One respondent cited having sweet pies/ pasties and 2 ate sweet biscuits 5 times or
more per week at 18 months.
An average of 1 in every 2 respondents had sweet biscuits 1-4 times per week.
At least one in 3 respondents ate canned/ packet soups 1-4 times per week and the rest
less than once per month or never for the 5 data collection periods.
The most commonly cited snacks were toast/sandwiches, crackers, fruit and vegetables.
Table 3 below shows the snack types usually eaten for the 4 reporting periods.
Table 3: Commonly Consumed Snacks
Snack type
% Respondents
Baseline
3 months
N=39 (%)
N=18 (%)
Sandwich/toast
7
(17.9) 6
(33.3)
Biscuits/cakes
12
(30.8) 2
(11.1)
Crackers
5
(12.8) 7
(38.9)
Fruit/vegetable
12
(30.8) 7
((38.9)
Tea
2
(5.1) 4
(22.2)
Chips
15
(38.5) 2
(11.1)
*Other
4
(10.3) 3
(16.7)
 Other= fizzy drinks, twisties, snack bars,
noodles, chocolate, tuna
6 months
12 months
18 months
N=19 (%)
N=14 (%)
N=17 (%)
6
(31.6) 8
(57.1) 7
(41.2)
3
(15.8) 3
(21.4) 3
(17.6)
8
(42.1) 2
((14.2) 5
(29.4)
12
(63.2) 7
(50)
9
(52.9)
1
(5.9)
4
(10.3) 1
(7.1) 3
(17.6)
5
(26.3) 2
(14.2) 7
(41.2)
ricies / weetbix, peanuts, scones, leftovers,
The results show that number of households choosing sandwich/toast and fruit/
vegetable snacks did not change much from 3 to 18 months. The numbers choosing
crackers also remained low with only 5 of the 17 households citing them at 18 months
data collection. Though the number of households citing snacks such as biscuits and
chips was also small (1-4), these remained snacks of choice from baseline to 18 months
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Tongan Community Action Programme – Phase 2
data collection. Additionally, other “unhealthy” options such as snack bars and chocolate
were still mentioned at 18 months.
The majority (at least 2 in every 3) of respondents said they ate snacks two to 4 times a
day from 3 to 18 months data collection periods. One to 3 respondents said they had
snacks four or more time per day during the same period.
Most respondents reported having snacks between 1 and 4 pm. The second most
popular times were 11-12am or 7-8pm in the evening. None ate snacks before 9am at 3,
6 and 12 months, with only 1 household reporting this at 18 months. There were 3-4
households that consumed snacks between 9 and 10 pm at 3, 6 and 18 months.
Healthy meals made at home (refer to page 23, Pantry Project)
Awareness of the importance of Healthy Food
 Increase intake of fruit and vegetables
 Healthier meals made at home
 Reduction in households consuming high fat and/or salt specialty breads
 Most households reported having cooked porridge and breakfast cereals 1-4 times
per week
 Most households have basic equipment and appliances for preparation of healthy
meals
 Food purchasing patterns were good with most families buying food once a week
 Frying as a cooking method has decreased
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Tongan Community Action Programme – Phase 2
2.5 Commitment to Healthy Lifestyles
This report is based on data collected over 5 reporting periods i.e. baseline, 3, 6, 12 and 18
months. The numbers of respondents were different for the 5 data collection periods. They were
also different for the various categories covered in the report.
For example, the number or respondents for fruit and vegetable consumption, food purchasing
patterns, household appliances, and children’s bed times were 40, 20, 30, 24 and 17 at
baseline, 3,6,12 and 18 months data collection periods respectively. At baseline, individual
respondents were interviewed but these were later grouped into households, hence the lower
numbers for subsequent data collections for the above categories. On the other hand, the
number of respondents for meat and fish, breads, cereals and miscellaneous foods
consumption were 29, 20, 30, 24 and 31 for the respective periods. All the total respondents
from baseline to 18 months represent individual respondents, not households for these food
categories.
Any numbers or percentages cited are with reference to the total respondents/ households for
the specified period, unless otherwise stated. Additionally, time frames will be specified for any
trends cited in the report. Statistical significance of changes mentioned in the report was not
determined and this should be taken into account when interpreting the findings.
Data analysis was conducted using summary tables and percentages cited are based on the
respondent numbers for each category and reporting period as mentioned previously. There
were limitations in some of the data or in the way some questions were asked. As a result,
some assumptions were used to assist with interpretation of the results (see assumptions
section). The categories used for grouping food consumption frequencies in the report are
different from those used in the questionnaire. This is due to combination of overlapping
categories into mutually exclusive ones for ease in percentage calculations and data
interpretation.
The report shows group and not individual results and trends as it was difficult to track the
changes for individuals due to an incomplete data set and coding at data entry.
The way certain foods were grouped in the food frequency questionnaire, especially meat
dishes combined lean and fatty meats or dishes using “healthy" and “non- healthy” cooking
methods. As a result, it is difficult to comment on whether the respondents were choosing lower
fat cuts of meat and cooking methods or not. What can be deduced is how often they ate certain
types of meat e.g. chicken or lamb.
Assumptions
1. Naming favourite fruits and vegetables does not indicate availability, affordability and
usual consumption by the respondent. However, for the purpose of the study, favourite
fruit/vegetable means what the respondents normally consume.
2. Though ownership of specified household appliances does not necessarily reflect
working condition or frequency of use, this report assumes that the respondents
regularly use them.
3. Waking and sleeping times for children were recorded but naps were not included. The
report assumes there are no naps during the day.
4. Though food consumption data is subject to respondent bias, the report assumes the
trends fairly reflect the dietary changes made by the respondents.
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Tongan Community Action Programme – Phase 2
5. Though the food categories used in the questionnaire do not include fish meat
alternatives, milk and milk products, takeaways, spreads, sauces and dressings, the
report assumes the categories covered give a fair picture of respondents’ general food
choices and consumption patterns.
Short term (up to one year)
●
Increased awareness of the importance of breakfast (Refer to page 30)
●
Increased intake of milk, fruit and vegetables
There were no questions relating to milk consumption over the five data collection
periods. All respondents reported eating fruit and vegetables though the variety for both
was limited
Increased awareness of the importance of fruit and vegetables
Participants indicated an increased awareness of the importance of fruit and vegetables
at the 18 month wave of data collection. The response choices in this section were ‘eat
more’, ‘eat less’ and ‘don’t know’.
o
o
o
o
at baseline 22 out of 30 participants indicated they were trying to eat more
vegetables
at 18 months 25 out of 28 participants indicated they were trying to eat more
vegetables
at baseline 24 out of 30 participants indicated they were trying to eat more fruit .
at 18 months 25 out of 28 participants indicated they were trying to eat more fruit
Fruits
Respondents were asked to name their favourite fruits. Oranges, apples and bananas
were the top three fruits mentioned at baseline, 3, 6, 12 and 18 months of the study.
Water / rock melons and mangoes were also popular at baseline but these were
mentioned by five households or less in subsequent reporting periods. Despite
pawpaws, pineapples, mangoes and water melons being part of the traditional Tongan
diet, these were mentioned by less than 40% of the households at 3, 6, 12 and 18
months. Grapes, pears, peaches, persimmons, nectarines, apricots, tamarillos, plums
and cherries were all mentioned by five households or less during the same period. This
was regardless of plentiful availability of some of the above fruits during some of the
data collection periods.
Vegetables
Respondents were asked to name their favourite vegetable/s. The most commonly cited
vegetable for the five reporting periods was carrot. This was followed by tomato at
baseline, 6, 12 and 18. Lettuce was second most popular vegetable at 3 months, with
tomato being as popular as carrots in the same period. The third most popular
vegetables were green leafy varieties (taro leaves, spinach or silver beet). Potato/
kumara, peas/ beans, capsicum, cauliflower, celery, cabbage, mushroom, onion, corn,
cucumber and beetroot were mentioned by four or less households at 3, 6, 12 and 18
months.
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Tongan Community Action Programme – Phase 2

Increased knowledge of food preparation and cooking skills
When asked how fruit was normally eaten, at least three in every four respondents said
they ate them raw or fresh at all the data collection points. Less than 30% (25%
baseline, 3mths=11%; 6mths=21% and 12mths=28%; 18 mths=17.6%) reported cooking
them. Some respondents also said they ate fruits as dessert but did not state whether
they cooked them or not before consumption.
Boiling/cooking was the most common (baseline=82.5%, 3mths=94.4%; 6mths= 63%;
12mths=85.7%) way of cooking vegetables. Steaming was the next preferred way of
cooking vegetables during the same period. However, steaming was the most preferred
method of cooking vegetables at 18 months, followed by boiling. Respondents citing raw
vegetable consumption remained low, with less than 50% mentioning this at baseline, 6,
12 and 18 months.
Despite one in every four respondents mentioning frying at baseline, only one
respondent (7.1% or less) mentioned it at 3, 6 12 and 18 months. Roasting was also not
very popular and was cited by four respondents or less (<21%) in the same period.
Intermediate term (1-3 years)
●
Increased healthy meals made at home
Respondents were generally citing healthier food preparation and cooking methods
such as steaming and raw vegetable consumption though continued education is still
required.
Breads and Cereals
The consumption of fatty and or salty bread and cereal products was low over 18
months from baseline. However, low consumption of most specialty breads may not
reflect better food choices but may simply reflect other constraints such as cost or
unfamiliarity of these foods to the respondents. Furthermore, the respondents may still
be purchasing other low cost, high salt breads available on the market.
At least 2 in every 3 households reported having cooked porridge or breakfast cereals
1-4 times per week. This could be attributed to the key messages provided during the
shared breakfast sessions. However, these figures are inconsistent with the low
numbers citing having a meal in the morning (refer to table 2). This could be due to
misinterpretation of the questions involved by the respondents.
Pasta consumption was low and rice was the preferred cereal by most respondents/
households. This could be due to participants’ taste preference and not cost as pasta
is reasonably inexpensive.
Respondents were asked how often they ate specified breads/ cereal foods.
Responses were grouped into 3 food consumption frequency categories:


Less than once per month or never
1-4 times per week
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Tongan Community Action Programme – Phase 2

5 times or more per week.
From 3 to 18 months data collection, the number of households citing they had eaten
the following breads / cereals less than once a month or never remained high (at least
3 in every 4):





Rewana bread
Doughboys Maori bread
Waffle/doughnut
Fruit or iced buns
Crumpet/croissant
There was also a general increase in the number of households who were eating
focaccia, bagel, pita, paraoa parai (fry bread) and other specialty breads less than
once a month or never in the same period.
The number of households consuming the above mentioned breads 1-4 times a week
remained generally low (5 households or less). No households ate Maori bread,
crumpets/croissants, waffle/doughnuts, fruit or iced buns five times or more from 3 to
18 months.
There was an increase in the number of households (2 in every 3) consuming cooked
porridge 1-4 times per week between 3 months to almost all (except 2 households) at
18 months. Only 4 households or less reported having porridge 5 times per week/
more or less than once per month/ never over the same period. There was no clear
trend for breakfast cereal consumption. However, 3 in every 4 households said they
ate breakfast cereal 1-4 times per week at 12 and 18 months data collection.
Additional 4-6 households ate breakfast cereals 5 times per week or more in the same
period.
At least half the households ate savoury/ dry biscuits, crispbread and crackers 1-4
times per week over the 5 data collection periods. However, 3 households or less said
they consumed the above foods 5 times per week or more in the same period.
At least 2 in every 3 households ate rice 1-4 times a week across the reporting
periods. The number of respondent who reported eating pasta less than once a month
or never steadily increased from 1 in every three at 3 months to at least one in every 2
at 18 months. There was a corresponding decrease in households eating pasta 1-4
times per week and 3 or fewer households having it 5 times per week or more.
Meat
When consumption of meat dishes is considered, it appears most or all households
eat one type of meat or another everyday of the week. Unfortunately, information
about quantities consumed was not available. However, the apparent regular meat
consumption significantly contributes to the intake of saturated fat and cholesterol.
This is supported by at least half the respondents citing consumption of different beef,
chicken, lamb/hogget dishes and saveloys 1-4 times per week at 18 months. These
dishes include potentially high fat ones such as casseroles and chops, unless visible
fat is trimmed or lean cuts are used. Additionally, close to 3 in every 4 respondents
said they consumed lamb roast/ chops 1-4 times a week at 18 months data collection.
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Tongan Community Action Programme – Phase 2
One to 2 households said they consumed some of the various meat dishes 5 times or
more per week. This further confirms that meat is an important part of the Tongan diet.
Ongoing education regarding appropriate portion sizes, frequency of consumption and
healthy preparation methods to reduce fat intake should be provided. This should be
combined with information on appropriate meat alternatives and budgeting.
When all data was considered across the 5 reporting periods, no clear trends could be
derived for most of the food categories as figures generally went up and down over
time. However, the information provided below broadly summarises the main
conclusions drawn from the available data. At least 1 in every 2 respondents said they
ate the following meat dishes 1-4 times per week at 18 months:






Beef mince dishes, rissoles, and meatloaf
Lamb-roast/chop
Lamb mixed dishes e.g. casserole, stir-fry
Chicken mixed dishes (e.g. casserole, stir-fry)
Chicken – roast, fried, steamed
Hogget/ mutton roast, chops
The majority of respondents (at least 3 in every four) had liver (including pate) and
other offal e.g. kidneys once a month or never. The rest (7 households or less)
consumed these 1-4 times per week for all data collection periods.
Between 30 and 46% respondents ate bacon, ham, luncheon meats, salami and
brawn 1-4 times a week with the rest having it less than once a month or never
between 3 and 18 months. Approximately 1 in 2 respondents ate saveloys 1-4 times
per week while the rest ate it less than once a month or never during the same period.
Twenty-two of the 31 households (71%) said they ate lamb roast/chops 1-4 times a
week at 18 months data collection.
Less than one in 3 respondents ate pork mixed dishes such as casserole or stirfry 1-4
times per week while the rest had these less than once a month or never at 6, 12 and
18 months. About 10-13 households (38-53%) respondents ate pork boiled bones 1-4
times per week while the rest ate it less than once a month or never at baseline, 3, 6
and 18 months.
One to 2 households or less reported eating some of the meat dishes mentioned
above 5 times per week or more from baseline to 18 months data collection.
Awareness of Fruit and Vegetable Consumption and Reduced Fat Intake
The results show that participants have increased awareness of the importance of fruit
and vegetable consumption. They also had increased awareness of the importance of
reducing fat in their diet. This could be attributed to on-going nutrition education as
well as shared breakfast sessions conducted for this population.
Fruits and Vegetables
The results show that the respondents’ fruit choices are limited mainly to oranges,
bananas and apples, despite the availability of other fruit varieties through out the
year. Additionally, fruits such as pineapples and mangoes, which are part of the Pacific
Page 41 of 87
Tongan Community Action Programme – Phase 2
island diet, were not eaten by most respondents. Vegetable varieties most commonly
consumed were also limited mainly to carrots, tomatoes, green leafy vegetables and
lettuce. This was despite several nutrition education sessions citing the benefits of
consuming a wide variety of vegetables and fruits.
The high cost of other options and not seasonal variation is the most likely explanation
for this. This is supported by the majority of respondents buying food from
supermarkets where fruits and vegetables may be more expensive than fruit/
vegetable shops. Additionally, cultural food preferences could be part of the reason,
especially where fruits and vegetables that are not typically part of the Tongan diet are
concerned.
This population may therefore not be getting the full benefits associated with eating a
variety of coloured fruits and vegetables. They should be encouraged to compare
prices in supermarkets and fruit and/or vegetable shops, using frozen or canned ones
over fresh to increase variety at a reasonable cost. Additionally, future education
sessions could cover supermarket tours, information on food prices and
encouragement on how to experiment with culturally unfamiliar foods to increase
variety. Since 70-80% respondents said they have a fridge or freezer, they could take
advantage of fruits and vegetables on special offer and freeze them for future use.
Meal Patterns
Reported meal patterns generally showed that some respondents do not eat breakfast
and or lunch but most eat the evening meal. Those who skipped meals probably
resorted to snacks at various times of the day as supported by 2 in every 3
respondents saying they ate these 2-4 times per day. At least 2 in every 3 respondents
said they had an evening meal between 5 and 7pm.
Less than one in five reported having meals between 8 and 9 pm. (refer to table 2).
Between 3 and 4 households reported having snacks between 9 and 10 pm. There is
need to continue encouraging regular meals, appropriate timing and frequency of
consumption. Education regarding healthy snacks is also required to reduce potential
weight gain. There is a need to continue educating the Tongan population preparation
of healthy, quick and easy packed lunches.
Meal times
The most commonly cited meal times were 8-9am, 12-1pm; 6-7pm.Table 4 shows the
percentage of respondents per meal time for the 5 reporting periods.
Table 4: Commonly cited meal times
Meal time
8-9am
12-1pm
5-7pm
8-9pm
Baseline
(n=39)
48.7%
36%
92.3%
23%
3 months
(n=18)
44.4%
38.8%
83.3%
-
6 months
(n=19)
26.3%
26.35%
100%
21%
12 months
(n=14)
14.2%
7.1%
64.3%
7.1%
18 months
(n= 17)
35.3%
35.3%
64.7%
17.6%
The results show that less than half the respondents have breakfast, just over a third
or less have lunch and the majority (64-100%) eat an evening meal between 5 and
7pm. The number of respondents having breakfast decreased from baseline (48.7%)
Page 42 of 87
Tongan Community Action Programme – Phase 2
to 12 months follow-up (14.2%). Less that a quarter of the respondents reported
having a meal between 8 and 9pm at baseline; 6, 12 and 18 months follow-up.
●
Commitment to healthy lifestyles by Tongan families
Lifestyle Modification
This section is a summary of the 12 month data collected over 5 reporting periods
i.e. baseline, 3, 6 12 and 18 months. The numbers of respondents were 40, 20, 30,
24 and 29 for each data collection period respectively.
The results show that some positive changes have been made in terms of healthier
food choices, food purchasing patterns and methods of cooking. However, on-going
education is required to ensure these positive trends continue. Though there is a
need for continued education across all components, special focus should be on
eating regular meals, methods of cooking (especially for vegetables) and own food
production as highlighted above.
Food Purchasing Patterns
Respondents were asked where they normally bought food. At least 7 in every 10
households mentioned supermarkets (Countdown, Pak n Save, Supervalue) as the
main source of food across the data collection periods. Fruit and/ or vegetable shops
(including Raeward and Funky Pumpkin) were mentioned by one in four respondents
or less at baseline, 6, 12 and 18 months. Only one respondent mentioned the local
dairy and/or Mad Butcher as a source of food at various reporting periods. Own
production was not a common source of vegetables or fruits with no respondents
citing it at 6 and 12 months and 3 or fewer at baseline, 3 and 18 months follow up.
At least half the households said they bought food once a week. The rest bought
food 2-3 times a week, with only one household reporting buying food daily at 6, 12
and 18 months.
Vegetable markets are still an important source of food but not as popular as
supermarkets. The Tongan community should still be encouraged to compare prices
and take advantage of cheaper, fresh, seasonal foods from the different suppliers.
Frequency of food purchasing and meal planning should also be discussed to help
them make optimum savings.
The low percentage of respondents (one household; 5.6%) buying vegetables from
the local dairy is a positive result for this population. Though dairy shops can be a
convenient source of basic food, they often do not have sufficient fresh fruit and
vegetables varieties to choose from. They should not be encouraged as a regular
source of fruit and vegetable supplies. Additionally, they may be more expensive
compared to supermarkets and fruit/ vegetable markets.
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Tongan Community Action Programme – Phase 2
Household Appliances
Seventy to 100% respondents reported owning a stove, oven, microwave, fridge,
freezer, electric jug/kettle or toaster at all data collection periods. Two in every 3
households or less also owned an electric frying pan, food processor, toastie maker
or rice cooker. Only one respondent reported owning a blender at baseline.
Working hours and Meeting Days
Though most participants reported working during the day, there are a few who work
mornings or afternoons only. These families are likely to have limited income to
afford the required dietary changes. Though the percentage of respondents citing
night shift is generally low (23.5% or less), it still has a significant impact for the
households concerned as it strongly influences food consumption patterns.
None of the respondents reported family members who worked during the weekends
at 18 months, which is a positive change especially where time to buy food and
family meals are concerned.
The most preferred day and meeting times was reported to be Saturday between 9
and 11 am. This time should be considered when planning any projects or events for
this population.
Children’s Sleeping Patterns
Respondents were asked what time children woke up and went to bed. Most of them
reported children getting out of bed between 6 and 7am for all data collection periods
except at 18 months where most children were getting up between 8 and 9 am. Most
children went to bed between 8 and 9pm for all the reporting periods. Assuming no
daytime naps, most children were awake for 11-15 hours per day.
The number of households reporting children went to bed later than 9pm decreased
from 6 at 3 months data collection to just one at 18 months. Only one respondent
reported children going to bed after 10pm.
Children’s sleeping patterns had generally improved with most getting out of bed
between 7 and 8 in the morning and going to bed between 8 and 9 at night. Only one
household had children sleeping after 10pm. On-going education should be provided
to address further concerns with this.
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Tongan Community Action Programme – Phase 2
2.6 School Holiday Programmes
The Christchurch Tongan Community Association (CTCA) initiated children’s programmes in the
January, April and July school holidays in 2007 and January 2008. These programmes ran for
two weeks in each of the holidays and included a focus on healthy nutrition and physical activity.
The Christchurch City Council, Sport Canterbury and the National Heart Foundation supported
these programmes. Support included funding, loan of sports equipment and the provision of
staff. The programmes included:




Swimming,
Hiking,
Play activities (outdoor and indoor) and
Healthy lunches
Short term (up to one year)
●
Increased intake of milk, fruit and vegetables
All respondents reported eating fruit and vegetables though the variety for both was
limited.
●
Increased knowledge of food preparation and cooking skills
Children prepared the healthy lunches under supervision by NHF staff and a Tongan
community health worker.
Relationships were developed and nurtured with local suppliers of fruits, veggies and
other healthy food stuffs.
The nutrition at the school holiday programmes is a significant contrast to two years ago
when the holiday programme lunches were fish and chips with sugar laden fizzy drinks.
Intermediate term (1-3 years)
●
Increased accessibility to and affordability of low fat, sugar and salt foods
According to respondents some positive changes have been made towards healthier
food choices.
●
Increased healthy meals made at home
Respondents were generally citing healthier food preparation and cooking methods such
as steaming and raw vegetable consumption though continued education is still
required.
●
Increased commitment to healthy lifestyles by Tongan families
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Tongan Community Action Programme – Phase 2
Ownership and exchange are the two fundamental tenets of Community Development in
the local environment (Shirley 2007). They are factors that govern access to resources
and are determinants of income and wealth.
Empowering the Tongan Community, through families, in Christchurch has been a
priority for TCAP2. In order to achieve sustainable outcomes for the Tongan community,
the NHF have endeavored to involve and support current and emerging Tongan leaders
in the evolution of this Community Activity.
Support options were discussed with the participants of the programme from the outset
and on an ongoing basis. These options included:
o
o
o
Exercise sessions,
Shared breakfasts/lunches,
instructional sessions (in Tongan and English language).
Food Preparation and Cooking Skills
When participants were asked how they ate fruits most of them cited raw fruit
consumption, which is in line with some of the nutrition education messages provided
during group sessions.
Most participants cited steaming as the preferred method of cooking vegetables at 18
months compared to boiling which was previously cited in previous data collection
periods. This was a positive change as steaming preserves more nutrients compared
with boiling. However, it should be noted that boiling was still popular as it was the
second preferred method of vegetable preparation at 18 months.
More education needs to be provided so that more people adopt preparation and
cooking methods that optimise nutrient retention in vegetable and fruits.
Less than half the households cited raw vegetable consumption over 18 months,
indicating it could be due to a taste preference for cooked over raw vegetables. Roasting
was also not popular and this could be due to the limited vegetable options and
inappropriateness of this method for cooking some of them e.g. green leafy varieties.
Though frying was mentioned by just one household at 6, 12 and 18 months, the
household concerned should get ongoing support so that healthier cooking methods are
adopted. Additionally, this should continue to be part of on-going group education
session to reduce fat consumption.
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Tongan Community Action Programme – Phase 2
2.7 Edible Gardens
Edible gardens were established in 20 participating families’ houses have been growing and
providing plenty of gardening exercise and healthy produce.
Short term (up to one year)
●
Increased capability to grow vegetables and fruit in own garden
Anecdotes from participants suggest that the older and younger generations tend to be
the gardeners in the families. Large colour photographs of the gardens adorn the walls
of the Tongan Community centre and competitions held for various varieties of produce.
This initiative ran parallel with a larger edible garden at the nearby Rowley Community
Centre where children from Rowley Primary School have been learning about edible
gardens from local gardening guru Lily White.
By October 2007 50 Tongan families had edible gardens growing at there homes. 20 of
these were the initial Rowley group and an additional 30 in the development at the Free
Church of Tonga.
In March 2008 Lily White did a follow up session with the TCAP intervention group as
well as the Free Church of Tongan group. Ten repeat sessions will happen between 12th
of April and 30th of June 2008.
Vegetables (Brassica and Broad beans) were provided to all participating families as a
way continuation of the focus on edible gardens. There are still 50 gardens in this off
shoot of the project.
There is a need for continued education and support regarding edible gardens as none
of the respondents to a phone survey cited their own production as a source of fruit and
vegetables at 12 months.
Three or fewer respondents cited own production as a source of fruits or vegetables at 6,
12 and 18 months while none did at baseline and 3 months. Alternatively, it could reflect
that the produce was not yet mature for consumption at the various data collection
periods and could therefore not be cited as one of the sources.
If there is apathy in taking up gardening as a way to increase fruit and vegetable
availability while increasing the level of physical activity, the cause of the apathy should
be further investigated. Alternatively, more innovative methods such as competitions,
growing vegetables for a cause e.g. charity should be investigated to encourage uptake.
Intermediate term (1-3 years)
●
Increased accessibility to and affordability of low fat, sugar and salt foods
According to respondents some positive changes have been made towards healthier
food choices.
Page 47 of 87
Tongan Community Action Programme – Phase 2
●
Increased commitment to healthy lifestyles by Tongan community leadership
Tongan Leadership
There have been significant events occurring in the wider Tongan context that have had
an indirect impact on the implementation of this project. These events include
constitutional unrest in Tonga and the death of the reigning Tongan monarch and his
son who was considered ‘the peoples Prince’.
In Christchurch the impact of these events has resulted in a particularly powerful
development. This was the appearance of the Tongan Council. The Tongan Council is a
leadership structure that brings together six leaders of the local churches and well as the
Tongan Community Association. This Council informs the elected Tongan representative
on the Christchurch Pacific Community Reference Group (PCRG).
The PCRG is administered by the Ministry of Pacific Island Affairs (MPIA) and is the
mandated consultative body on Pacific community issues in Christchurch. In 2004 the
National Heart Foundation engaged with the PCRG to consult on the direction and
process for implementing the TCAP.
The Tongan Council and the contextual events that acted as a catalist it have provided
an environment with the potential to have significant benefit for the wider Tongan
community in Christchurch. In November 2007 the Principal Investigator received a
verbal invitation to attend the Tongan Council in 2008. The purpose of this invitation is to
speak with the Tongan Leadership about the TCAP and to explore what opportunities
may exist for developing health programmes for the wider Tongan community.
Strategic meeting with Free Church of Tonga
On Wednesday the 2nd of April 2008 Heart Foundation representatives met with
Reverend Semisi Fonua, President of the Free Tongan Church.
Rev Fonua came to New Zealand to speak and liaise with social service interests with
the Ministry of Social Developments department of Child Youth and Family and Family
and Community Services.
Ifalame Teisi was invited to Auckland to attend this forum and was proactive in brokering
the meeting with the Heart Foundation. Ifalame has worked with his head Church
Minister in Christchurch over the few months to encourage increased participation in
nutrition and physical activity based activities.
As a result of Ifalame’s advocacy the President of the Free Tongan Church wrote to the
Heart Foundation for more information about its programmes. There are around 5000
Tongans nationally who belong to the Free Tongan church in New Zealand.
The community based setting of the initial TCAP has allowed participants to work in their
own environment and religious and cultural beliefs to be incorporated. Community
approaches in health promotion empower individuals and communities to gain control
over the determinants of their own health and without community participation, long term
health gains in populations are unlikely to be achieved (Egger et al 2004).
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Tongan Community Action Programme – Phase 2
In New Zealand, churches have become the centre of community life for many Pacific
Islands people and they have been successfully used as a setting for weight loss and
smoking cessation programs in Pacific Island communities (Bell et al 2001).
From July to December the Free Church of Tonga and original Rowley based group
were have been working collaboratively sharing knowledge and resources.
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Tongan Community Action Programme – Phase 2
2.8 Tongan Community Workforce Development
Developing technical and professional capabilities of the Pacific (Including Tongan) community
workforce has been and will remain a significant focus for the Heart Foundation.
Short term (up to one year)
●
Increased knowledge of food preparation and cooking skills (Refer to page )
●
Increased capability to grow vegetables and fruit in own garden (Refer to page )
●
Increased capacity in the Tongan community workforce (Up to one year)
Since the start of the programme in October 2006 the following training opportunities
have been provided:






Chip Frying Awareness
SI Health Provider Fono
Cert. Pacific Nutrition
Smokefree Cessation Training
Health Promotion Forum
Pacific Fono Nutrition Advisory Group
October 2006
November 2006
December 2006 – February 2007
January 2007
February 2007
September 2007
Certificate of Pacific Nutrition
We now have five 1 from 2004, 2 from 2006, and 2 from 2007. Two of these five are
currently in leadership roles; two more are in support roles. The fifth person is involved
in mental health (problem gambling). Two members of the wider Tongan community
completed this tertiary qualification in 2007 bringing the total number of Tongan
graduates to five.
This certificate is important within the Tongan community as tertiary education is closely
correlated with upward social mobility, more effective use of health information and
better adult health outcomes (Pacific Health Chart Book 2004). Currently the Pacific
youth enrolment rate in tertiary study is only half the national average (Statistics New
Zealand 2002).
A further Certificate in Pacific Nutrition programme was scheduled to be run in
September 2007. This course was cancelled due to an insufficient number of
participants. This has highlighted that greater flexibility is required in order to support
workforce development that meets the needs of the Pacific community in Christchurch
and particularly the Tongan community.
Further information on the certificate as well as education and employment statistics are
available from the previous PMR as well as from Statistics New Zealand and the Ministry
of Pacific Island Affairs.
Page 50 of 87
Tongan Community Action Programme – Phase 2
The NHF supports the “for Pacific, by Pacific” approach to programme delivery and for
this there needs to be workforce development. Funding individuals to attend courses
assists communities to help themselves and also empowers individuals. There is
opportunity here for skill transfer and information exchange, two of the acknowledged
principles of capacity building.
Free Church of Tonga
In addition to previous activity the National Heart Foundation has continued to engage
and work with the Free Church of Tonga in the following ways.

Developing a community champion (Church based Case Study)
Reverend Ifalame Teisi and six others from his church are a part of the
Tongan Community Action Programme research component which began in
October 2006 with ethics approval. They are 7 of the 40 consented
participants.
Reverend Teisi has become a champion for improving Tongan health in
Christchurch. After achieving the PIHB nutrition certificate in 2007 Rev Teisi
assisted with the Tongan School holiday programmes and from July to
September 2007 ran his own Healthy Eating programme based on his PIHB
training for his Church community and other Tongan and Samoan people
from the local community. He presented on 12 Saturdays.
The Heart Foundation paid for the food demonstrations, edible gardens,
physical activity sessions and shared meals as part of the Tongan
Community Action Programme. Currently 30 families are growing their edible
gardens. A tutor is providing another tuition session on vegetable gardening
soon and we are providing further seedings and broadbeans for the winter
crop this month.
Rev Teisi is planning further Saturday sessions from April to June 2008 which
will receive funding support from the Heart Foundation. Rev Teisi and his wife
have been regularly attending physical activity sessions in a local fitness
centre that have been funding by the Heart Foundation. Rev Teisi has also
facilitated a further ten shared meal sessions which ran between 18 April and
30 June 2008.
Rev Teisi has now been transferred to Auckland by the Free Church of Tonga
to establish a Tongan community health outreach project for the Free Church.
This project is to be a pilot initiative with the potential to expand to other Free
Churches of Tonga in Australia and the United States of America.
This opportunity has happened as a direct result of advocacy by the NHF
office in Christchurch to the president of the Free Church of Tonga based in
Tonga. The next challenge for the Free Church in Christchurch is to groom a
successor to continue the health promotion initiatives that Rev Teisi
developed and progressed.
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Tongan Community Action Programme – Phase 2
Intermediate term (1-3 years)
●
Increased commitment to healthy lifestyles by Tongan families (Refer to pages 20-21)
●
Increased commitment to healthy lifestyles by Tongan community leadership (Refer to
pages 22-23)
●
Increased capacity in the Tongan community workforce (One to three years)


Pacific Fono Nutrition Advisory Group
Nutrition and Physical Activity Forum*
28 September 2007
12 June 2008
(* This regional forum was held in Christchurch, co-ordinated by Agencies for Nutrition
Action (www.ana.org.nz) and supported by Ministry of Health and Sport and Recreation
New Zealand)
Developing a community champion (Community based Case Study)
Tokanga Vehikite has been facilitating the TCAP intervention since July 2007. Tokanga
took over this role in order for her to lead, learn and grow as a community health worker
in the Tongan Community in Christchurch.
Tokanga has now been contracted as a Community Health worker with Partnership
Health Canterbury (PHC) for three years from July 2008 – June 2011. PHC is a Primary
Health Organisation (PHO).
Tokanga has continued to take on leadership roles including a recent initiative called
Feeding our Futures.
Feeding our Futures is a national social marketing programme, delivered by the Health
Sponsorship Council, which helps parents and caregivers to achieve healthy diets for
kids. The programme prioritizes Maori, Pacific and low income communities.
Tokanga and another TCAP participant have been attending an initiative based in the
high Pacific demographic suburb of Rowley. It is a joint initiative between the Cancer
Society and National Heart Foundation. The participants are learning more about healthy
eating and cooking for their families. Tokanga has been facilitating and another is one of
a group of 14 learning.
Tokanga has been demonstrating healthy food preparation, with recipes and health
messages being provided. Tokanga demonstrates one meal and the participants take
home the ingredients that evening to make the recipe for their families. Recipes have
included meals like:



Beef stir fry
Home made hamburgers
Home made muesli
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Tongan Community Action Programme – Phase 2
Tongan Wesleyan Church
In February 2008 the Tongan Wesleyan Church expressed interest in developing their
own programme to achieve health outcomes for church members. Rev Sioeli Ofa
contacted the NHF when putting together their Easter Youth Programme. NHF
contributed $400 in funding for bread products and fresh fruit and vegetables.
The Heart Foundation has provided resources for shared breakfasts and instructional
sessions. Food has included cereals, fish, fruit and vegetables. Support was also
provided by Couplands bakeries in Christchurch who provided bread and buns.
The activity with the Tongan Wesleyan Church is another example of Tongan
community action evolving through the relationships that have been nurtured through
the structure of the initial TCAP.
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Tongan Community Action Programme – Phase 2
2.9 Feedback from Tongan Families
This section covers data collected from individuals representing 11 families. Data was collected
either by self completed questionnaires or for those who are not fluent in English by the
facilitator. This section contains information from the baseline, three, six, 12 and 18 month data.
This section is presented differently to the previous eight programme activity sections. This is
because the research feedback applies across several activity and outcome areas. Short and
intermediate term outcomes from the logic model can be referred to in previous sections.
Short term (up to one year)
●
Increased capacity in the Tongan community workforce up to one year (Refer pages 25-26)
Intermediate term (1-3 years)
●
Increased commitment to healthy lifestyles by Tongan families (Refer to pages 20-21)
●
Increased commitment to healthy lifestyles by Tongan community leadership (Refer to
pages 22-23)
●
Increased capacity in the Tongan community workforce - One to three years (Refer to pages
25-26)
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Tongan Community Action Programme – Phase 2
Part Three – Sustainability
3.1 Long term outcomes (3-5years) – Sustaining change
Analysis of the 18 month data collection is expected to provide some evidence towards longer
term outcomes. These outcomes are:
●
●
●
●
Increased health of Tongan community in Christchurch
Reduced Health Inequalities
Sustained Change
Increased Community Connectedness
The first two sections have not been addressed at this stage however some information is
provided below towards ‘Sustained Change’ and ‘Increased Community Connectedness’.
3.1.1 Sustaining change through Leadership
Synergies with other programmes
Partnering with other organizations and initiatives improves synergies and sustainability.
Rowley Primary School is involved in the Fruit in Schools (FIS) programme for ten low decile
schools in Christchurch and information sharing occurs frequently between staff and participants
involved in both these programmes.
Funding Support
Initial funding for two years was provided for the TCAP project was from the Heart Foundation
and Canterbury Community Trust in 2006. Support and funding also came from Partnership
Health Canterbury.
Funding support has subsequently come from:



Partnership Health Canterbury
Cancer Society for Edible gardens from 2006-2008
Ministry of Health funding through Canterbury District Health Board for the
evaluation component for this financial year (October 2007 – September
2008)
Next Steps
As a result a programme of action is being considered with a strong focus on ongoing
empowerment, collaborative initiatives and sustainable outcomes.
NHF and the Cancer society were partners with the Feeding our Futures (FOF) campaign with
Tokanga as the lead presenter. The Cancer Society has been supportive of the TCAP since its
initial conception. Requests for supporting an ongoing intervention are strong from the
participants and the Christchurch Tongan Community.
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Tongan Community Action Programme – Phase 2
The information contained within this report contributes to our ongoing planning and decision
making going forward. Other areas of well being have been identified in order to further
strengthen the Tongan community in Christchurch. These areas of wellbeing include:
Social wellbeing

Housing - Link in with the CCC with the housing figures in relation to overcrowding
looking at state rental, housing, insulation and other relevant health determinants

Strategies for Kids, Information for Parents (SKIP) – SKIP is a parenting initiative that
the Christchurch Tongan Community Association has entered into with Family and
Community Services (Ministry of Social Development)
Cultural wellbeing

Issues of heritage and identity are also on the wider government agenda. Given the
dynamic nature of this community action project in a cross cultural context there are
likely to be opportunities to explore and identify cultural outcomes.
Sustainability

As the end of the TCAP initiative draws nearer, time and space will be made to
reflect on the TCAP process and what features of sustainability exist or have been
enhanced as a result of the project. Ayre, Clough and Norris (2002) identify three
Sustainability Streams which are leadership, learning and communicating.
Community engagement
Community Engagement is a critical tenet of a participatory democracy. Twyford (2006)
summarizes Community Engagement as any process that involves the community in
problem-solving or decision-making and uses community input to make better decisions.
The Christchurch Tongan Community has been engaged in the TCAP from the start and
the extent and effectiveness of this engagement should be explored.
This dialogue should include any one who has a stake in the Tongan community in
Christchurch particularly with respect to health outcomes. Some starter concepts and
questions could include:
o
o
o
o
o
o
o
o
Increasing Tongan community connectedness
A Partnerships continuum
20 year Future Visioning dialogue
SWAT analysis
Community Capacity Framework
What is the value of inter sectoral partnerships?
What are the characteristics of a healthy community?
Generating leadership everywhere and shapes its own future
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Tongan Community Action Programme – Phase 2
3.1.2 Sustaining change through learning
Intercultural & Professional Development
One area identified by the project advisory group was intercultural development for
mainstream providers delivering to pacific communities. Inter-culturalism includes
competencies, knowledge and skills that assist a practitioner in delivering services
across two or more cultural perspectives.
The NHF recognizes the prerogative of the Tongan community to deliver to their own
community. NHF also recognize that their staff has technical knowledge and skills that
does not currently reside with the Tongan community in Christchurch.
In April 2008 Bridget Chiwawa, a dietician working for the NHF, delivered a Public Health
Research presentation to the NHF South Island Regional Training day. Bridget, who is
from Zimbabwe, delivered a clinical review of the TCAP research methodology. Bridget
also discussed ethical, consultation and cultural considerations for projects like TCAP in
the future.
The presentation was an example of the dynamic area that is action research and the
importance of pre and ongoing planning, execution, evaluation and review processes.
Cultural Worldviews
The principal investigator of the project continues to source best and innovative ‘next’
practice processes that could contribute to the TCAP and other similar action research
projects going forward. While acknowledging there is immense diversity amongst
Pacific people it is useful to note that for some participants their cultural views, language
and history may lead them to a different worldview of health which may influence the
way “they perceive, access and use health service and (sic) can influence the outcomes
of interventions” (MoH 2008a pg. 17). The MoH (2008a pg.17) quotes Tukitonga stating
that “in general, Pacific culture and beliefs about health and illness are different from
those of mainstream New Zealand; as health is considered to be a holistic notion and a
family concern rather than an individual matter”.
The MoH (2008a pg 27) reports that advertising campaigns promoting messages such
healthy eating have not been effectively reaching Pacific people, suggesting that the
methods of information delivery or promotion are not always useful, because of the
diversity of Pacific views and priorities.
3.1.3 Sustaining change through communicating
Appropriate opportunities for communicating the TCAP intervention
and outcomes are constantly being sought after.
The project featured in the Ministry of Health’s HEHA Action
Report in March 2008 (Issue number 8, Page 6). A copy of this
article is shown to the right.
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Tongan Community Action Programme – Phase 2
The article focused on the development process, implementation and some outcomes of the
project so far. Some important factors included the youthful Tongan demography, barriers to
changing lifestyle and the engagement process with Tongan community and stakeholders.
.
Page 58 of 87
Tongan Community Action Programme – Phase 2
3.2 Increased Community Connectedness
3.2.1 High level of community support
The TCAP programme has had the support of a high number of community organisations.
Below are a list of those organisations that have and continue to support the project to date
and a description of their involvement. Representatives from these groups also attend an
inter-organisational advisory group for the programme.

Cancer Society - Support for Edible gardens including gardens in 20 households,
gardening instruction and a community garden based at the Rowley Community
House and 30 from the group at the Free Church of Tonga.

Christchurch City Council - Support across Community Services including
development, engagement, funding and recreation services.

He Oranga Pounamu - Resource provision including pedometers

Medlab South - Medical laboratory services in house and community based.

Ministry of Pacific Island Affairs - Supporting Pacific Community consultation and
engagement. Providing advice on Pacific relevant policies across government sector.

Sport Canterbury - Providing staff for training Tongan Community leaders in Physical
Activities appropriate for preschool, primary and secondary school aged children.
Providing equipment and sporting resources for Tongan school holiday programmes.

Pacific Trust Canterbury - Support from Dr Alistair Humphrey, Dr Api Talemaitonga,
management and nursing staff from the trust. They have also provided measuring
equipment and some administrative support.

Christchurch School of Medicine and Health Sciences - Supporting Principal
investigator with project evaluation

Community and Public Health - Providing advice on Public Health issues
Page 59 of 87
Tongan Community Action Programme – Phase 2
3.2.2 Partnership Health Canterbury
Partnership Health Canterbury (PHC) is a Primary Healthcare Organisation (PHO) which is
providing additional support services
Services to Improve Access (SIA)
SIA is a support programme funded by PHC. ‘Services to Improve Access’ is a programme
about helping individuals receive appropriate health care resources so they can maintain or
improve their health and independence. A number of barriers exist to access for the
Tongan people in Christchurch and outskirts including Ashburton.
SIA allows community workers to support people with high health risk factors to access
general medical practitioners and other health services in Canterbury.
The TCAP2 coordinator works 17 per week with the project and this is now complemented
with nine hours per week SIA. In March 2007 the Christchurch Tongan Community
Association (CTCA) was contracted to deliver SIA.
CTCA and Pacific Trust Canterbury (PTC) are both contracted to deliver SIA and the CTCA
and PTC staff continue to work in collaboration to assist TCAP2 participants to access
health services during the six month evaluation of the project. Copies of results go to
participants GPsGPs.
Recent discussions between PHC and Tongan Community leadership have focused on
ongoing development and support for the Tongan communities in Christchurch.
Care Plus
Care Plus is a nationwide service run through PHOs for people with chronic diseases or
other high health needs. Tongan participants with diabetes are receiving support through
this service which aims to:
 Improve quality of life
 Reduce hospitalisations
 Improve management of chronic conditions
 Reduce inequalities
 Facilitate teamwork within PHOs
 Increase access for high-need primary health users
Community Action To Improve Nutrition Capacity (CATINC)
CATINC is a collaborative PHO initiative established to improve nutritional capacity in
identified communities of interest in Christchurch. The initiative uses a community action
approach which involves enabling and empowering communities to build their own
responses to identified nutritional needs.
The project is working in the Rowley Area where the TCAP programme is based and the
Tongan project facilitator and principal investigator have provided community engagement
and development advice to the CATINC project co-ordinator and nutritionist. The coPage 60 of 87
Tongan Community Action Programme – Phase 2
ordinator and nutritionists jobs are to work with communities most in need of nutrition
education and enabling them to make healthy food choices.
The initiatives with a focus on supporting Pacific communities of interest and include:





Increasing knowledge in general practices on good nutrition
Educating church and community groups on healthy foods
Ensuring vending machines are sugar free
Improving access to fresh fruit and vegetables
Eliminating junk food advertising from communities
3.2.3 Professional Relationships
The two TCAP2 intervention coordinators are developing and nurturing relationships with
other related organisations in the area’s of health, local government and social services.
In September 2007 one of the coordinators attended a national Pacific Nutrition Advisory
Group. The purpose of this group is to connect practitioners and support the
communication of good practice when working with Pasifika peoples in Aotearoa New
Zealand.
Although difficult to quantify, relationships with experienced practitioners and
knowledgeable individuals can provide significant value to our coordinators. These
professional relationships provide:



mentoring opportunities
peer support and supervision
coaching opportunities
Page 61 of 87
Tongan Community Action Programme – Phase 2
Part Four – Discussion, Conclusions and Recommendations
4.1
Discussion - Process Success Factors
The approach taken in this section has been to discuss and identify Process Success Factors
relating to the impact and outcomes of the project. The challenge was then to evaluate the
extent to which each of these factors work.
Figure 4.1 below illustrates the context and impact that the TCAP2 has had within the Tongan
community in Christchurch. At the beginning of the project 40 people consented to participating
in the project. Over the three month period of the initial intervention a further 81 individuals
became engaged with the project by ‘organic referral’. These people were friends and family of
the 40 participants.
Over the following 15 months two significant Tongan groups became engaged and self initiated
programmes for their own groups. These were the Free Church of Tonga and the Wesleyan
church Youth group. In both cases the initiators were consented participants of the project.
As conservative estimate, the TCAP2 project has engaged more than 200 (19% of population)
and possibly as many as 380 Tongan community members (35% of population).
Figure 4.1
TCAP2 Impact context
Christchurch Tongan community
population x 1,071
Community
Stakeholder
organisations:
Government &
Not for Profit
~60 Wesleyan
Church Youth
x40
Consented
~200 Free
Church of Tonga
x81 other
participants
In order to provide clarity of process during the analysis and evaluation of information a matrix
was developed. This matrix provided a framework for discussing and considering outcome
areas and reflecting back on process factors had a successful impact and/or outcome on the
project.
The matrix includes input from within the project team and from external stakeholders
represented by the Project Advisory Group. It became clear that the discussion, conclusions
and recommendations should focus on three areas of impact which were:
1. The 40 consented participants
2. The Christchurch Tongan Community
3. Community Stakeholder organisations, including local and central government
agencies, not for profit organisations and community groups
Page 62 of 87
Tongan Community Action Programme – Phase 2
Primary focus: 40 consented participants
1. Community Development and Support
a. Workforce
b. SIA worker
c. Local leadership
d. Bi-lingual capabilities and recognition of learning preferences
e. Community Capacity
2. Access
a. Resources
b. Flexibility
c. Primary Care Engagement
Secondary focus: Christchurch Tongan Community
3. Tongan Community Engagement / Participation
a. Consultation,
b. Guided Decision Making,
c. Timeframes
d. Community focus
e. Supporting Community Action
f. Community Development Approach
Tertiary focus: Community Stakeholder Organisations
4. Partnerships / Connectedness
a. Internal Organisational Capability
b. Partnerships (Edible Gardens)
c. Funding support
d. Collaboration
e. Coordination
f. Cooperation
g. Networking
5. Research and Development
a. Formation
b. Process (data collection)
Page 63 of 87
Tongan Community Action Programme – Phase 2
Primary group: The 40 participants
Increased Health In the Tongan Community
(1) Community Development and Support
PSF
Outcome areas
Key: PSF = Process Success Factor
Discussion
Conclusion
Recommendation
a) Community Workforce
development and support
Worked well, Five 5 trained PIHB Nutrition Certificate.
Internal community dynamics emerged after it was found that
one PIHB trained Tongan person engaged to deliver was not
accepted by some members of the participating group.
Identifying & developing
health leadership within
community of interest
works best.
Replicate as important to
find & support local
leadership. Strong
recommendation.
b) SIA worker
This role was identified as the project developed to meet
community needs and was funded by Partnership Health
Canterbury. As a high needs community the SIA worker role is
very important. Positive outcome, reduces barrier to linking to
GPs. Provides explanations for importance of linking to GP
A follow up plan is
required particularly for
the high risk participants
to improve health
outcomes.
Priority for sustained long
term outcomes
c) Local Leadership
Building local leadership for ownership, motivation, connecting
and mentoring. Needs leaders who show enthusiasm and
commitment. Mentoring was effective for four local community
and church leaders. This included brokering connections,
coaching and mentoring. This approach was referred to as
‘Tongan for Tongan’.
Development and support
of local leadership
worked well
Strong Recommendation
to support local
leadership.
d) Bi-lingual capabilities
and recognition of learning
preferences
Very important for role modelling and so that community
understands the health messages and values eg Havili
translating for Lily at Edible gardens. Tokanga did all
presentations in Tongan as well as English. Visual / Pictorial
resources created and provided
Repeat as high priority for
education to improve
access
Strong recommendation
Facilitator and resources
e) Community Capacity
Brokering linkages has been an important skill to nurture within
the Tongan community leadership. A successful example of this
is the connections made between the TCAP and CATINC
projects. Consistent with Partnerships Continuum (VicHealth
2005).
Partnerships provide a
functional platform for
building community
capacity.
Supporting the brokering
of linkages is a strong
recommendation.
Page 64 of 87
Tongan Community Action Programme – Phase 2
(2) Access
PSF
Outcome areas
Discussion
Conclusion
Recommendation
a) Awareness
raising
Increased access to information, raising awareness. Bi-lingual
communication and delivery of key health messages is critical. There is a
need to ensure translation retains original meaning for message consistency.
Messages should also be visual, simple and culturally appropriate. ‘Talanoa’
means dialogue in Tongan & Samoan
Resources in Tongan
and English, ‘Talanoa’
in Tongan. Use visual,
simplified & culturally
appropriate resources
Strong recommendation
to have leaders
speaking own language.
Utilise simple, visual &
culturally appropriate
resources.
b) Resources
Enhancing access to resources, that the community would not otherwise
have access to, is a critical approach. Barriers identified included availability,
time, cost, lack of transport, childcare, knowledge and skills. Resources
focussed at a community level in order to facilitate whole community change.
Need to resource.
There was raised
awareness of the
importance of
breakfast
consumption though
implementation was
variable among the
households at 18
months data
collection.
Need to resource areas
that enhance access to
health including
availability, time, costs,
lack of transport,
childcare, knowledge
and skills.
Need to facilitate change for better outcomes, edible gardens provided
materials and tuition, Food for shared breakfast sessions coupled with key
health messages was provided and participants encouraged to make their
own breakfast. Sessions timed (at 9am) to show the importance of breakfast.
Participants were given opportunity to go to The Active Room (a local fitness
centre) then physical activity sessions and equipment were provided at their
own venue. Own photos of food preparation edible gardens, PA sessions etc
Face to face (Known as Talanoa) very important. Equipment, group trainer
provided.
Explore opportunities to integrate nutritional (ie vegetable gardens) and
physical activity focused initiatives with church activities. Lifestyle factors
such as “the lack of time for recreation/shift work’ are barriers that must be
responded to. Engagement with Church leadership is important eg Free
Tongan Church and Reverend Teisi.
Page 65 of 87
Tongan Community Action Programme – Phase 2
c) Flexibility
A community Action approach was encouraged and provided for flexibility,
innovation and responsiveness. Provided wok, plants, lemon tree, etc ,
recumbent bike and some equipment. Also required plates, pots and cutlery
to enable the leaders to provide healthy food gatherings and for group
participation in the preparation. Key Health messages were incorporated into
incentive package eg ”Make water/milk beverages of choice” on children’s
mugs/ plates. Healthy recipes form Heart Foundation books were provided
with the woks.
Introducing incentives
at the beginning of the
project and ensure
incentives link well
with key health
messages & desired
behaviour changes.
High needs communities
need to be resourced?
If participants are part of
the process to prepare
healthy food it is an
excellent teaching
environment
d) Primary Care
Engagement
Services to Improve Access (SIA) worker appointed and was a strong
positive outcome after intervention. Tokanga started SIA work July 2008 on a
three year part time contract. Tokanga working as an independent contractor
and is receiving PHO support from Partnership Health Canterbury as well as
volunteered mentoring support as a sole trader.
Important part of
future planning for
PHO’s.
Strong recommendation
Page 66 of 87
Tongan Community Action Programme – Phase 2
Secondary group: Christchurch Tongan Community
Reduced Health Inequalities
PSF
Outcome areas
(3) Tongan Community Engagement / Participation
a) Consultation
Discussion
Consultation to gain a shared understanding of the needs, aspirations &
priorities for that community of interest was very important. Engagement
approach worked well from the outset where support was offered to the
Tongan community leadership.
Setting a culturally appropriate frame from the outset was very important to
the success of the project. This cultural frame includes a world view on health
that is different to that promoted by health authorities in New Zealand.
Education is also an important factor. Pasifika peoples need the right
information about health in an appropriate way in order to shift a cultural
mindset. This can be carried out through normal activities that Pacific peoples
engage in, whether it be a church service, sports day, youth/womens’ group
meetings.
Conclusion
Recommendation
Consultation is very
important prior to the
project design. This buy
in drives ownership of
the project. Consultation
that is well thought
through, early,
meaningful and ongoing
provides a strong
partnership platform for
the project
Needs to be taken into
consideration. Repeat
for further projects
b) Guided
Decision Making
The purpose of engaging with the Tongan Community leadership was to
make better decisions for the project. The focus was on sustainable
development. Decisions made around the sustainability of the project
included the areas of leadership, learning and communications. The
implementation included input from community on what, when and how.
Community
Engagement is a
process by which better
decisions are the
outcome.
Critical to engage
stakeholders early,
meaningfully and
ongoing through
project.
c) Timeframes
The process allowed appropriate time frame expectations and consultation.
Throughout the formation and process of this project the tendency was to be
optimistic around the timeframes required. Slower time line was needed to
allow time at each stage to get buy in from the community. Best practise
engagement with Pasifika peoples is to have early, ongoing and meaningful
consultation with respect to an initiative or project. Particular areas were with
respect to Pacific community engagement, the Ethics approval process and
data collections. The Community Action approach did not always align
smoothly with ethics application process.
Consultation extremely
important. Provide
sufficient time frames
for similar projects and
build in extra time for
early and ongoing
consultation,
unexpected delays and
for celebrating
successes.
Priority for any project
like this to have good
consultation
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Tongan Community Action Programme – Phase 2
d) Community
focus
Project coordinators were mindful of the needs communities on low incomes
have during the process development for this project. Opportunities were
made for appropriate messages regarding cheap, healthy food options.
These health messages were provided at the beginning of the programme
followed by cooking demonstration sessions at Rowley community House in
April 2008. Budgeting needs to be an integral part of menu planning. Tongan
community participants have high numbers in families and households, less
access to physical activity, clubs, gyms, less time for recreation, and many
work shift work. Shift work is a complication for families sharing meals
together.
Concentrate on making
access easier for
healthy food and
physical activity during
the process
development of future
projects. Practical eg’s
on affordable, healthier
food choices can be
achieved e.g. through
cooking demonstrations.
Strong priority. Ensure
community
development drives
menu planning to be
culturally appropriate.
e) Supporting
Community
Action
Developing a commitment to role modelling healthy food at social events.
Healthy food provided at every event. Good education and role modelling.
Participants were involved in food preparation so key messages were
demonstrated and this strengthened community involvement e.g. a Christmas
barbeque with whole fish, chicken and vegetable kebabs and salads was
held. Children and teenagers were involved in the food preparation.
This needed funding so
the community is able to
learn from healthy food
provided and strengthen
community action.
Strong priority to
provide healthy food
and have it funded
Page 68 of 87
Tongan Community Action Programme – Phase 2
f) Community
Development
approach
Creating an environment that promotes healthy lifestyles in local
communities. Linkages to the Early Childhood Centres (ECCs), local schools
and other Tongan community groups. All organisations need to create healthy
environment for the local community. Facilitate linkages: Free Tongan
Church, Wesleyan Church and Holiday Programme all funded as part of
project. Cooking demonstrations at Rowley House held in April 2008 were
advertised through schools and ECCs in that community with a positive
outcome.
Inter-link with all
community groups
within the area
Needs to be a priority
Stronger the linkages
and relationships the
better. Positive
outcomes eg funding
Wesleyan Church
An analogy has been used of ‘Seeds falling from the tree and growing
themselves’ with respect to the TCAP project. A number of these extra
measures happened as a direct result of having the TCAP project.
Some of the seeds include:










SIA worker position established
Other HEHA programmes
Diabetes breakfasts in Bromley
Gardens in the community (cancer society)
Elma Sturgess at Rowley Community House being on CATINC
advisory and piloting Great little cook book
Increased intersectoral relationships
CATINC funding the pacific nutrition course
PHO funding for TCAP project
Project highlighted in Partnership Health Canterbury (PHC)
annual report
MOU to be signed between PHC and Tongan Association
This is an indication that the community development approach within
the TCAP was supported by the intersectoral agencies involved. This
is a key outcome for the project and it is expected that the
sustainability and growth of other community initiatives will lead to
community change over time.
Page 69 of 87
Tongan Community Action Programme – Phase 2
Tertiary Focus: Stakeholder Organisations
Increased Community Connectedness
(4) Organisational Capability and Partnerships
CSF
Outcome areas
a) Internal Organisational
Capability
Discussion
As most of the community attend mainstream providers it is
important to increase the skill and knowledge of these
organisations to ensure that services are organised and
delivered in a culturally competent and effective way (MoH
2008).
Conclusion
Building Pasifika
organisational capability
provides more
knowledgeable and
responsive mainstream
workforce
Continue to build
Pasifika
organisational
capability and
support mainstream
providers to increase
their knowledge and
awareness of
culturally appropriate
services.
Edible gardens involved
children, adults and
grandparents. Benefits of
gardening should continue
to be highlighted in future
and linked to desired
health benefits. Cancer
Society funded the edible
gardens as a part of
project collaboration.
Included edible
gardens component
and related key
messages
Over the period of the project a significant number of
stakeholders have developed relationships with Pacific
community representatives. This has provided the platform for
developing and nurturing individual knowledge and competencies
and brokering partnerships.
b) Partnerships (Edible
gardens)
Education given, rotational garden continues for 50 families
Cancer Society 2 year funding for gardens. Households
participated in the edible garden photo competitions and received
prizes. Seeds and plants were provided three times over the 18
months including broad beans and cabbages for the winter crop.
Grand parents and children enjoyed helping out in the gardens.
Key messages should reinforce the link between gardening,
increased physical activity, access to fresh vegetables and fruits
to potential health benefits and improved access to food.
Recommendation
Page 70 of 87
Tongan Community Action Programme – Phase 2
c) Funding support
Organisations facilitated funding and identified champions for
workforce development Worked well – There was a strong level
of co-operacy (interdependence) observed between
stakeholders. These were central Government (MPIA), local
Government (CCC), Partnership Health Canterbury (PHO), notfor-profits, community and funding organisations (including
CDHB). Strong support by individuals also like Dr Anne
Richardson (School of Med), Dr Api Talemaitonga, Dr Alistair
Humphrey (C&PH)
Organisations especially
Government agencies
have a community / social
responsibility to support
high needs communities
Organisations take a
strategic approach to
apply for funding and
support workforce
development
d) Cooperation
Facilitate whole community approach (Co-operation / Interdependence). Surveys required finding most suitable times to
hold gatherings. Project leaders need to be funded if possible.
Provided breakfast at gatherings to provide education and also
thru the food demonstrations. Education on the relationship
between breakfast consumption and meal timing was provided.
This continually needs to be re-enforced with a focus on blood
glucose & cholesterol control.
Strong leadership
facilitates whole
community approach.
Gatherings provided an
effective discussion forum
for health messages.
Target funding support
and resources to groups.
Priority that
leadership be
strengthened in
order to facilitate
whole community
approach. Funding
support and
resources targeted
towards groups.
e) Collaboration
Multi stakeholder collaboration with a focus on Guardianship The
establishment of the initial inter-agency group and terms of
reference was important. The groups’ role was one of
guardianship and facilitation as opposed to governance.
Working with Ministry of
Pacific Island Affairs
(MPIA) worked well to
identify the group. 2
presentations to Pacific
Community Reference
Group (CRG)
stakeholders provide
strategic support, face to
face must be all provided
by own community
leaders
Ongoing interagency
collaboration plays
an important
structural and
facilitative role for
connecting,
leadership and
communicating.
This differentiation is important as it strikes to the heart of project
purpose and ownership. Throughout the project a conscious
effort was made to empower the Tongan community and provide
them with developmental and support opportunities.
Funding from several groups. Need to provide ongoing
communication. Initially set up the stakeholder group.
Facilitating the community development behind the scenes
Page 71 of 87
Tongan Community Action Programme – Phase 2
f) Coordination
Co-ordinating linkages to GPs, PHOs, TLAs, Heart Foundation
worked well as all aim for all to be linked to the GPs. PHO
funded the SIA worker. Opportunities to link into the TLA. The
Heart Foundation has the resources and information for heart
health and nutrition.
Need strong links with
lead organisation role
modelling strong
leadership
Organisations
partner to
coordinated
leadership
g) Networking
Organisations were proactive in searching out opportunities for
linkages Some participants went to Bromley Diabetes breakfast
needs another sentence to explain what this is.
PHO provided some
funding and strong
linkage.
Important to have a
collaborate approach
overall.
Page 72 of 87
Tongan Community Action Programme – Phase 2
Process Focus: Research and development
Increased Community Connectedness
CSF
Outcome areas
a) Formative
Discussion
Conclusion
Recommendation
Ethics for administering questionnaires and collection of biochemical
and anthropometric measurements. Ethics provided the
opportunity to record qualitative & quantitative metrics showing high
risk indicators. Pacific rates for cardio vascular disease (CVD) are
consistently and significantly higher than those in the total
population as is mortality due to CVD (MoH 2005; NHF).
Good baseline for health
promotion and community
development project.
Evidence recorded so no
need to replicate. May not
need ethics research
component but strong
recommendation
that
they must be closely
linked to GPs
(4) Research
Although there is only one participant in the TCAP who has been
diagnosed as diabetic (prior to the programme beginning) the high
glycated haemoglobins indicate that almost 50% of this group are at
high risk of developing diabetes. In fact, at 18 months ten
participants meet the WHO criteria for diagnosis of Diabetes.
The MoH (2008a) reports that although Pacific people are enrolled
in Get Checked at higher rates than other groups; Pacific 92% Maori
27% and European/Other 63%, they have poor rates of retinal
screening and less than satisfactory diabetes control, suggesting
barriers to care and that “Pacific people for various reasons may not
understand the importance of diabetes management’” pg. 23.
b) Process (data
collection)
The data collection process has been discussed and consideration
given to the appropriateness of invasive data collection (volume &
frequency) to this community of interest. The focus on ethics may
have limited (real or perceived) community based evaluation for this
project.
Ethics approval would be
needed for information
gathering and analysis. If
there was a programme
without the research
component and was just
evaluated for
effectiveness evaluated
that would be different –
eg using the Active
Canterbury tool
Volume and frequency of
data collection for this
project could have been
clearer and more specific
to outcomes sought.
Consider ethics process
with respect to end
outcomes desired for
each project community
of interest.
Initial data collection facilitated awareness that some participants did
not have a GP and that it is important to strengthen these links with
GP with regular follow up. This is particularly relevant for the
identification of high risk participants.
Page 73 of 87
Tongan Community Action Programme – Phase 2
4.2
Recommendations
The following recommendations are encouraged for future projects that have a focus on:




increasing health in Tongan communities,
Reducing Tongan health inequalities,
Increasing Community Connectedness, and
Research and development pertaining to Tongan communities in Aotearoa New
Zealand.
These recommendations are likely to have some relevance to working with other Pasifika
nations.
Increased Health in the Tongan Community (Primary focus: 40 consented participants)
Community Development and Support
 Continue development and support for community workforce as it enhances local
leadership.
 SIA worker provides capacity for sustained long term outcomes and is a priority
being met by Partnership Health Canterbury (PHO)
 Continue developing and supporting local leadership for ownership, motivation and
mentoring.
 Support and utilise facilitators with bi-lingual capabilities and development of bilingual resources recognising learning preferences of that community of interest.
 Supporting the brokering of linkages to develop community capacity.
Access
 Support awareness raising and community engagement through local leaders
communicating in their own language and community channels. This is enhanced by
utilising simple, visual & culturally appropriate resources.
 Continue resourcing areas that enhance access to health including availability, time,
costs, lack of transport, childcare, knowledge and skills
 Community Action approach encourages and provides for flexibility, innovation and
responsiveness. Encourage initiatives supporting participation in the process of
preparing healthy food
 Engagement with Primary Care is an important part of future planning for PHO’s
Reduced Health Inequalities (Secondary focus: Christchurch Tongan Community)
Tongan Community Engagement / Participation
 Best practice consultation is extremely important for Pasifika focused initiatives.
 For effective Guided Decision Making it is critical to engage Pasifika stakeholders
early, meaningfully and ongoing through project.
 For effective consultation allow flexibility in timeframes.
 Consider community cultural frame and appropriateness when menu planning.
 Supporting Community Action by developing a commitment to role modeling healthy
food at every opportunity. A Community Development approach will strengthen
linkages and relationships for sustainable change.
Page 74 of 87
Tongan Community Action Programme – Phase 2
Increased Community Connectedness (Tertiary focus: Community Stakeholders)
Partnerships / Connectedness
 Pasifika community stakeholders benefit from developing organisational capability.
 Edible gardens and related key messages are effective components of nutrition
focused initiatives.
 Synergies are achieved by organisations taking a strategic approach to funding.
 Continue interagency collaboration for connecting, leading and communicating
initiatives.
 Strengthen leadership coordination in order to facilitate whole community approach.
 Target funding support and resources to support high needs communities and
organisations take a strategic approach to apply for funding to support these groups.
 Resource co-ordination between partner organisations.
 Resource networking opportunities for Pasifika community stakeholders.
Research and Development
 Evidence recorded so no similar projects may not need to replicate with ethics research
component. Link future projects to General Practices for sustainability.
 Future projects consider ethics process with respect to end outcomes desired for the
community of interest of each project.
Page 75 of 87
Tongan Community Action Programme – Phase 2
Part Five – Bibliography
Bell et al 2004
Egger, G., Spark, R., & Donovan, R. (2004). Health Promotion Strategies and Methods (2 ed.).
Australia: McGraw-Hill.
Edwards D., 2006. Pacific Community Action Project Formative and Process Evaluation. Otago
University Student Project.
Facilitating Community Change, Community Initiatives Inc (2002) ISBN 1-879502-39-9
Health Research Council of New Zealand. Guidelines on Pacific Health Research Third edition,
May 2005. http://www.hrc.govt.nz
Health Research Council of New Zealand. Strategic Plan for Pacific Health research 2006
– 2010. February 2006. http://www.hrc.govt.nz
http://www.stats.govt.nz
http://www.minpac.govt.nz
Koloto, A., 2007. Pacific Housing Experiences: Developing Trends and Issues. A report
prepared for Centre for Housing Research Aotearoa New Zealand and the Ministry of
Pacific Island Affairs.
Ministry of Health (2005) The Health of Pacific Peoples - Wellington
Ministry of Health.(a) 2008. Improving Quality of Care for Pacific Peoples. Wellington: Ministry of
Health.
Ministry of Health.(b) 2008. A Portrait of Health. Key Results of the 2006/2007 New Zealand
Health Survey. Wellington: Ministry of Health.
New Zealand Guidelines Group. 2003. The Assessment and Management of Cardiovascular
Risk. Wellington.
Shirley, I., 2007. Community Development Practice in New Zealand. New Zealand Institute of
Public Policy
Twyford, V. 2006. Beyond Public Meetings; Connecting Community engagement with DecisionMaking.
ISBN-13:978-0-646-46720-7.
Page 76 of 87
Tongan Community Action Programme – Phase 2
Part Six – Appendices
TCAP Questionnaire
Tongan Community Action Programme - Participant questionnaire
Malo e lelei,
We would like to know a little about you to make your programme work better. Please answer the following questions
as best you can.

What are your families’ favourite fruits?
_________________________________________________________________________________

How does your family normally eat these?
(raw, cooked, in a dessert, etc.)
_________________________________________________________________________________

What are your families’ favourite vegetables?
_________________________________________________________________________________

How does your family normally eat these? (raw, steamed, fried, roasted, boiled, etc)
_________________________________________________________________________________

Where does your family normally buy their food from?
_________________________________________________________________________________

How often does your family buy food from these places in a week?
_________________________________________________________________________________

What types of meals are usually cooked at home?
_________________________________________________________________________________

8am

What times do your family usually eat a meal? (Please circle the closest hours)
9am
10am
11am
12
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
What kind of snacks do your family members eat?
_________________________________________________________________________________

How many snacks does your family normally eat in a day?
_________________________________________________________________________________

8am

What times in the day do your family members usually eat a snack?
9am
11am
12
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
How do family members normally get around? (Please circle)
Walk

10am
Car
Bus
Cycle
Other_____________________
What are your family members’ favourite physical activities?
_________________________________________________________________________________
Page 77 of 87
Tongan Community Action Programme – Phase 2

How often do your family members do these activities?
_________________________________________________________________________________

What are your families’ favourite sports/games?
_________________________________________________________________________________

How often do your family members play these?
_________________________________________________________________________________

How many people live in your house?
_________________________________________________________________________________

What ages are the people in your house? (Please write the number of people in your house that are within each
age bracket)
0-5


6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
66-70
When do the people in your house normally work? (Please circle all that apply)
Mornings
During the day
Afternoons
Nights
Weekends
What of the following appliances do you have in your house? (Please circle all the appliances that you have in
your house)
Oven
Stove
Microwave
Fridge
Freezer
Jug/Kettle
Toaster
Electric Fry pan
Toastie-Maker
Food Processor
Rice cooker
Other____________________________________________________________

Do you have a GP/Doctor?

If YES, what is the name of your GP/doctor _____________________________________________

When was the last time someone from your family saw a GP / Doctor? ________________________

On average how many hours a day is your TV on? (Please tick one)
0 hours

70+
Up to 1 hour
1-2 hours
YES / NO (Please circle one)
2-3 hours
3-4 hours
4-5 hours
5-6 hours
6-7 hours
7-8 hours
More than 8 hours
What are the best days and times for you to attend a regular gathering? (Please tick days and times)
Monday
8-9am
Tuesday
9-10am
Wednesday
10-11am
11-12
noon
Thursday
12noon1pm
1-2pm
Friday
2-3pm

What time do children in your house normally wake

What time do children in your house normally go to bed.
Saturday
3-4pm
4-5pm
Sunday
5-6pm
6-7pm
7-8pm
_____________________________________
________________________________
Malo aupito – Thank you for taking the time to complete this questionnaire.
Page 78 of 87
Tongan Community Action Programme – Phase 2
Appendix 2 - Survey
Tongan Community Action Programme
Participant Assessment Form
(1 September 2006)
Malo e lelei, we would like to know a little more about what you are thinking regarding nutrition and physical activity. Please answer
the following questions as best you can.
There are FIVE possible responses to each question: Strongly disagree, disagree, undecided, agree, and strongly agree. Fill in the
circle that best describes how much you agree or disagree with each statement.
For other questions there also five responses that describe how often the statement applies to you: Never, Seldom, Occasionally,
Often or Repeatedly.
First name: _______________________ Last name (Surname): ______________________________
Agree
Undecided
 I have started to exercise regularly, and I plan to
continue 1 (action)
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 I have lined up with a friend to start exercising regularly
within the next few weeks 1 (preparation)
    
 When I feel tired, I make myself exercise anyway
because I know I will feel better afterwards 2 (maintenance)
    
 I could exercise regularly, but I don't plan to 1
    
    
 I am satisfied with being an inactive person 1 M
(precontemplation)
 I have been thinking about whether I will be able to
exercise regularly 1 (contemplation)
 I am afraid of the consequences to my health if I do not
exercise 2 (contemplation)
 I reward myself when I don't eat Lu-Pulu / Vai Siaine /
Lu Sipi / To’okutu 4 M (action0
 I have been exercising regularly for a long time and I
plan to continue 1 (maintenance)
 I don't exercise and right now I don't care 1 (precontemplation)
 I am finally exercising regularly
1 (action)
(precontemplation)
 I think regular exercise is good, but I can't figure it into
my schedule right now 1 (precontemplation)
Strongly
Disagree
Disagree
Strongly
Agree
Date of birth: ___________________________
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Page 79 of 87
Tongan Community Action Programme – Phase 2
Never
Seldom
Occasionally
Often
Repeatedly
 When I am tempted to eat Lu-Pulu / Vai Siaine / Lu Sipi /
To’okutu, I eat something else 4 M (maintenance)
    
 About eating vegetables, in what way are you trying to
change 5
 About eating fruit, in what way are you trying to change
  
  
  
5
 About eating Lu-Pulu / Vai Siaine / Lu Sipi / To’okutu, in
what way are you trying to change 5 M
Are you seriously thinking of quitting smoking? (Tick one)
 Yes, within the next 30 days *
 Yes, within the next 6 months *
 No, not thinking of quitting *
Each rung of the ladder represents where various smokers
are in their thinking about smoking. Circle the number that
indicates where you are now. 6
10 Taking action to quit (e.g. cutting down, enrolling in a
quit programme)
9
8 Starting to think about how to change my smoking
patterns
7
6
5 Think I should quit but not quite ready
4
3
Don’t
know
Eat less
    
Eat more
 I tell myself I can choose to eat Lu-Pulu / Vai Siaine / Lu
Sipi / To’okutu or not 4 M (action)
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Page 80 of 87
Tongan Community Action Programme – Phase 2
2 Think I need to consider quitting some day
1
0
No thought about quitting
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Page 81 of 87
Tongan Community Action Programme – Phase 2
How often do you usually eat these foods? 5 Please fill one circle for each food.
Miscellaneous Never
Cakes, scones
or pikelets
Muffins – all
types
Sweet pies or
sweet pastries
Other puddings
or desserts (not
including milkbased
puddings)
Plain sweet
biscuits
Cream filled or
chocolate
biscuits
Canned or
packet soup (in
winter)
Less
than
once per
month
1-3
times
per
week1
Once
per
week
2-4
times
per
week
5-6
times
per
week
Once
per day
2 or
more
times
per day
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How often do you usually eat these foods? 5 Please fill one circle for each food.
Never
Less
1-3
Once
2-4
5-6
Once
Bread and
than
times
per
times
times
per day
Cereal Foods
once per
month
Focaccia,
bagel, pita,
other
specialty
breads
Paraoa Parai
(frybread)
Rewana bread
Doughboys or
Maori bread
Crumpet or
croissant
Waffle or
doughnut
Fruit or iced
buns
Savoury / dry
biscuits,
crispbread,
crackers
per
week1
week
per
week
per
week
2 or
more
times
per day
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Page 82 of 87
Tongan Community Action Programme – Phase 2
Cooked
porridge
Breakfast
cereal
(including
muesli)
Rice
(including
white or
brown)
Pasta (e.g
spaghetti,
ravioli,
macaroni,
noodles)
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Page 83 of 87
Tongan Community Action Programme – Phase 2
How often do you usually eat these foods? 5 Please fill one circle for each food.
Meat and
Fish
Beef mince
dishes (e.g.
rissoles,
meatloaf)
Beef or veal
mixed dishes
(e.g casserole,
stirfry)
Corned beef
(including
canned) or
brisket
Hogget or
mutton –
roast, chops
Lamb mixed
dishes (e.g.
casserole,
stirfry)
Lamb – roast,
chop
Pork mixed
dishes (e.g.
casserole,
stirfry)
Pork – roast,
chop, steak
Pork –boiled
bones
Sausage,
frankfurter or
saveloy
Bacon or ham
Luncheon
meats, salami
or brawn
Liver
(including
pate)
Other offal
(e,g, kidneys)
Chicken
mixed dishes
(e.g.
casserole,
stirfry)
Never
Less
than
once per
month
1-3
times
per
week1
Once
per
week
2-4
times
per
week
5-6
times
per
week
Once
per day
2 or
more
times
per day
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Page 84 of 87
Tongan Community Action Programme – Phase 2
Chicken –
roast, fried,
steamed,
BBQ
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Page 85 of 87
Tongan Community Action Programme – Phase 2
 On average, how many servings of fruit (fresh, frozen, canned or stewed) do you eat per
day? 5
Do not include fruit juice or dried fruit. (Please mark one only)
(a ‘serving’ = 1 medium piece or 2 small pieces of fruit or 12 cup of stewed fruit)
e.g. 1 apple + 2 small apricots = 2 servings
Per Day
 I don’t eat fruit
 Less than 1 per day
 1 serving
 2 servings
 3 or more servings
 On average, how many servings of vegetables (fresh, frozen, canned) do you eat a day?
5
Do not include vegetable juices. (Please mark one only)
(a ‘serving’ = 1 medium potato/kumara or 12 cup cooked vegetables or 1 cup of salad
vegetables)
e.g. 2 medium potatoes + 12 cup of peas = 3 servings
Per Day
 I don’t eat vegetables
 Less than 1 per day
 1 serving
 2 servings
 3 servings
 4 or more servings
 Are there any foods that have been left out that you think are important to add
(i.e. taro).
Malo aupito – Thank you for taking the time to complete this assessment form.
Page 86 of 87
Tongan Community Action Programme – Phase 2
References
1.
Marcus, B. H., Selby, V. C., Niaura, R. S., & Rossi, J. S. (1992). Self-efficacy and the stages of
exercise behavior change. Research Quarterly for Exercise and Sport, 63, 60-66.
2.
Nigg, C.R., Norman G.J., Rossi, J.S. & Benisovich, S.V. (March, 1999). Processes of exercise
behavior change: Redeveloping the scale. Poster presented at SBM. San Diego, CA
3.
McConnaughy, E. N., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in
psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research and Practice,
20, 368-375.
4.
Prochaska, J. O., Velicer, W. F., DiClemente, C. C., & Fava, J. L. (1988). Measuring the
processes of change: Applications to the cessation of smoking. Journal of Consulting and Clinical
Psychology, 56, 520-528.
5.
Russell, D., Parnell, W., & Wilson, N. (1999). NZ Food: NZ People: Key results of the 1997
National Nutrition Survey: Ministry of Health.
6.
Biener, L., & Abrams, D. (1991). The Contemplation Ladder: Validation of a measure of
readiness to consider smoking cessation. Health Psychology, 10(5), 360-365.
*
These questions were supplied by Mark Wallace-Bell and are from the Stages of Change
literature, though I am not sure were. However, I assume they are validated otherwise they would
not have been forwarded
M Question has been modified slightly to suit the Pacific Community Project. These modifications
are in italics.
Note: Lu-Pulu, Vai Siaine , Lu Sipi and To’okutu are all traditional Tongan dishes that are high in
fats. Lu-Pulu is corned beef cooked in cream. Vai Siaine is bananas cooked in coconut cream. Lu
Sipi is lamb cooked in coconut cream. To’okutu is a coconut dumpling.
Page 87 of 87