Pacific Health

Increased Reports of Depression in Hawaiʻi during the first wave of COVID-19

Katherine Aumer — 2023-05-03

Introduction: Reports of mental health issues increased nationally in the USA during the COVID-19 pandemic, often attributed to the effects of quarantine, isolation, and restriction of travel. Given that Hawaiʻi State’s population is unique in its largely ethnic minority population, geographic isolation, and economic dependence on tourism, it is important to document if similar mental health outcomes have occurred during the beginning of the COVID-19 pandemic.

Methods: This study compares Hawaiʻi’s rates of depression using data from the National Center for Health Statistics collected in 2020 and the Hawaiʻi Behavioral Risk Factor Surveillance System collected in 2016.

Results: Hawaiʻi’s rate of depression, like the rest of the nation, increased significantly during the first wave. A chi-square test of independence was conducted, and the results were significant, χ²(1, n = 20,261.42) = 582.48, p < .001. Before COVID-19, typical rates of depression were at 11.03%, 95% CI [10.51%, 11.55%]. During the COVID-19 pandemic, reports of depression increased to 24.23%, 95% CI [23.16%, 25.31%].

Conclusion: Depressive symptoms doubled during the early stages of the pandemic in Hawaiʻi. Evidence-based strategies should be developed now to help prevent future possible mental health related issues that are attributable to pandemic related safety protocols.

Digital health and Universal Health Coverage: Opportunities and policy considerations for low- and middle-income Pacific Island countries and territories

Adam Craig — 2023-08-31

Introduction: Providing affordable, accessible, quality health services is critical to attaining Universal Health Coverage (UHC). Despite this, progress in many Pacific Island countries and territories could be faster. Digital health is an advancement in information communication technology that is anticipated to change health care delivery.

Methods: A systematic review of the literature and 5-years of Pacific Heads of Health, Pacific Health Ministers, and WHO’s (Western Pacific) Regional Committee meeting reports was conducted. In addition, an umbrella review of the literature pertaining to digital health's use to address health systems challenges in low-and middle-income countries was undertaken and key-informant interviews with policymakers, digital health managers, technical advisors, development specialists, and donors were held. Data was thematically analysed using an inductive approach. Finally, a series of consultations were held with Pacific Health Information Network members to test findings and refine recommendations.

Results/Discussion: Four broad UHC-related challenges and associated priority digital health responses were identified. The challenges identified were a need to: (i) build systems for the collection and timely exchange of health data to support clinical management and health system planning; (ii) address barriers to accessing quality health care services (particularly in rural areas); (iii) improve mechanisms for communication between health staff and functions of the health system, and (iv) address workforce training and essential skills development. Priority digital health responses identified include electronic health and patient information systems, telehealth, digital stock and supply chain management systems, technology-supported collection and linkage of population data, digitally enabled health worker-to health-worker communication and digital clinical decision-making.

Conclusion: While digital health can enhance health system function through accelerated access to and exchange of information, it does not replace fundamental health systems components such as a sufficient skilled health workforce, supply chains, health reporting, financing, or governance. Where adopted appropriately, digital health offers opportunities to improve the efficiency and effectiveness of established health enterprises and improve access to equitable and quality health care.

Factors influencing rural Timor-Leste women’s utilisation of family planning services

Angelita Maria Gomes — 2023-12-03

In Timor-Leste, maternal fertility and mortality rates have been reducing over the past two decades; however, unmet family planning needs remain. Family planning is especially relevant for women with low socio-economic status as they often have unmet family planning needs, which is pertinent for Timor-Leste as its population experiences high rates of poverty and primarily lives rurally. Our qualitative descriptive study explores rural Timorese women’s knowledge, attitudes, and family planning practices to determine factors influencing their family planning decision-making. Purposive sampling resulted in twenty-five women from the rural Suai-Covalima district participating in three focus groups.

While rural women preferred family planning, many lacked knowledge about specific methods, including misunderstandings about side effects and impact on fertility. Health literacy is central to improving understanding of family planning. Therefore, enhancing service providers’ capacity to provide accurate and up-to-date information and training is necessary to build rural women's understanding of family planning. The patriarchal nature of the Timorese society strongly influenced women’s family planning decisions. Hence, including men in future family planning education is essential. Despite the historical influence of the Catholic Church in Timor-Leste, women in this study did not feel its teachings influenced their family planning decisions. Further research exploring the role of the Church in reproductive decision-making and encompassing broader rural Timorese populations, including men, would increase understanding of family-planning decision-making and its influences.