Developing a child health survey for a Pacific Island nation. Integrating the Delphi method with Pacific methodologies

Abstract

Introduction: There is minimal information available that describes the health of children of primary school age (5-12 years) living in the Pacific. Current tools that exist for measurement of health have not been developed with Pacific paradigms in mind. Our objective was to describe the development of a culturally and contextually appropriate health survey to enable measurement of the health status of 5-12 year olds living in a Pacific Island Nation. Methods: Integrating a Delphi method with Pacific methodologies, two rounds of online questionnaires involving 33 panel members reviewed what to include in a health survey for primary school-aged children living in Tonga. The panel consisted of paediatric clinicians and academics, teachers and parents from Tonga, New Zealand, USA, and the UK. Results: Panel consensus was met on a range of domains to be included in the survey including: general demographics (80%), environment (80%), resilience and risk (88%), household economics (80%), psychological functioning (92%), social functioning (92%), physical functioning (88%), cognitive functioning (92%) and individual health conditions (84%). Particular importance was placed on including questions that described exposure of children to violence and abuse (93%). Conclusions: Based upon the consensus of a diverse expert panel, the domains that are necessary for the measurement of health in primary school-aged children living in Tonga were identified. The Delphi method proved a valid and useful technique to assist with the development of such a health survey and enabled the incorporation of a Pacific lens – a Tongan understanding of measuring children’s health.

Surviving versus thriving: The wellbeing of primary school aged children in Tonga

“…16 A more indepth description of the intertwining of Pacific frameworks has been described elsewhere. 12 Collaboration was initiated with the Tongan Ministries of Health and Education, WHO country representatives and University of the South Pacific leaders. Partnership followed with Tongan academics and health experts, as well as connection with primary school principals and teachers.…”

“…A Delphi method 12 and an audit of hospital data 13 informed the content of the questionnaire. The Delphi study involved a diverse panel of 33 experts including child health clinicians, researchers, teachers and caregivers.…”

“…The Kakala framework, a Tongan research framework based on the weaving of flower garlands, was intertwined with the phases of survey development 15 and Talanga , a two‐way communication process with an emphasis on listening, was used as a framework for communication, collaboration and partnership 16 . A more in‐depth description of the intertwining of Pacific frameworks has been described elsewhere 12 …”

Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands

“…A wide range of stakeholders was canvassed, literature was reviewed, hospital data analysed, 15 and Pacific methodologies overlapped with a Delphi Process. 16 An exploratory study piloting the survey was completed in three primary schools in Nuku'alofa, Tonga (Fig. 1).…”

“…With unanimous support ethical approval was gained from the University of Auckland Human Participants Ethics Committee (Reference 010569) and the Tonga National Health Ethics and Research Committee (Reference 040614.1). A wide range of stakeholders was canvassed, literature was reviewed, hospital data analysed, 15 and Pacific methodologies overlapped with a Delphi Process 16 . An exploratory study piloting the survey was completed in three primary schools in Nuku'alofa, Tonga (Fig.…”