Le Ala’ is a community action research project led by Pacific people from a range of academic and clinical disciplines. It aims to increase Pacific peoples’ understanding of alcohol- and drug-related harm and encourage activities that reduce its likelihood.
This study takes stock of Pacific alcohol and drug (A&D) services and interventions targeted at Pacific communities in New Zealand. It includes a comprehensive literature review that provides insights into relevant A&D services provided, and interventions carried out, nationally and internationally with ‘cultural communities’.
Purpose
The purposes of this stocktake were to:
- inform Le Ala’s work by providing evidence of relevant interventions and services that are effective in helping to prevent alcohol misuse and related risk-taking behaviours within Pacific populations, and that seek to reduce alcohol-related harm
- provide a resource for the communities of interest in this field
- identify issues that will confront funders, researchers and communities of interest in providing A&D services for a rapidly changing and increasingly diverse Pacific population.
Methodology
Information was collected mainly through dialogue with a diverse range of A&D and other social service providers (managers and staff), District Health Board (DHB) funders and planners, A&D clinicians and practitioners, service users and others. More than 100 people participated in fono, face-to-face meetings, interviews and a survey.
Participants were asked to answer questions such as:
- How do you identify those at-risk of developing alcohol-related harm?
- What interventions are working well with Pacifi c people? How do you know? Why?
- What interventions are not working with Pacifi c people? How do you know? Why?
- What interventions do you think work better with Pacifi c people? Why?
The study also included a short literature review, with a key source of information being the Le Ala Alcohol Community Interventions and Services for Pacifi c Peoples Literature Review (Warren et al 2006), which provides important insights into A&D interventions with cultural minorities in New Zealand and overseas. The review also included publications obtained through bibliographic searches of databases such as Medline, Embase, Cinahl and Psychinfo, the Cochrane Database of Systematic Reviews and other internet sources.
The researchers initially intended to develop a guide for evaluating evidence of the effectiveness (including cost effectiveness and cost benefi ts if possible) of service delivery related to A&D and alcohol-associated issues for Pacifi c peoples. However, this did not eventuate, as feedback from informants highlighted a distinct gap in the availability of evidence-based information. Service providers said that in many cases funding was not available for them to undertake rigorous evaluations of their services, and this included maintaining appropriate data-collection systems to support service evaluations.
This research follows a suite of studies (entitled PADOPTS – the Pacific Alcohol & Drug Outcomes Project) commissioned in recent years by the Alcohol Advisory Council of New Zealand (ALAC), which concentrated on Pacific providers’ delivery of treatment services. While this stocktake provides some information on services’ treatment and care, its prime focus is on issues pertaining to prevention and health-promotion interventions targeted at Pacific populations. In addition, it explores service capacity and capability matters relevant to Le Ala’s aims and objectives.
Key Results
A significant finding of this review was the apparent lack of available national and international information on evidence-based Pacific A&D interventions.
This is understandable in the New Zealand context given the relatively recent development and establishment of Pacific providers and Pacifi c-targeted interventions. It’s also important to emphasise that specific research on Pacific A&D prevention is largely under-developed – again, not surprising given that providers deliver treatment-based interventions with a limited focus on prevention strategies.
This stocktake shows that A&D service delivery is inextricably linked to the Government’s existing funding arrangements, which target the 3% of the population with ‘substantial to severe’ alcohol-related problems. This continues to create a significant gap in the provision of prevention services and interventions.
(Further research is required to determine those who are ‘at risk’ in Pacific communities. According to A&D practitioners, a range of variables may define them, with some providers mentioning that at-risk service users are mostly captured through referrals from government agencies such as the Ministry of Justice and Department of Corrections).
Pacific A&D services provide a variety of interventions, including counselling, psycho-educational sessions, music therapy (pese) and psychodrama. Some offer spiritual and traditional healing services. They use a combination of Pacific and mainstream models of care, and while many interventions are provided in English, some services are provided in Pacific languages.
According to interviewees, the programmes delivered by Pacific A&D services are generally effective. It was unclear, however, whether structured evaluations had been carried out to support this view. Although many of the service providers recognised the importance of evaluation, a lack of resources prevented them doing so. Programme evaluation is critical to ascertain whether programmes are addressing the needs of Pacific peoples effectively.
The characteristics of effective interventions are accessibility, cultural appropriateness, alignment with Pacific health belief models and acknowledgement of the increasingly diverse Pacific peoples, particularly the increasing number of New Zealand-born Pacific youth who have dual/multiple ethnicities. Including alcohol users’ families in interventions and using inclusive approaches are thought to be important, and fono participants favoured church- and school-based approaches.
Identified service gaps have been attributed to a lack of funding and inadequate skills. This includes insufficient staff trained in A&D programme delivery together with shortfalls in the number of staff required to provide more programmes. This lack of resources prevents most service providers developing, implementing and evaluating prevention strategies to reduce alcohol-related harm among Pacific communities.
The stocktake also revealed insights into the rapidly changing socio-demographic characteristics of the Pacific population – and went a step further to take a closer look at their potential impacts in the future. The changes will become more obvious as a large, young, New Zealand-born-and-raised cohort with different social characteristics and experiences from the first generation comes of age. Services designed to meet the needs of, and respond to, the consumption patterns of the earlier Pacific migrant cohort will have to be expanded and or modified.