Factors to consider in Micronesian food-based interventions: a case study of preventing vitamin A deficiency.

BACKGROUND: Many factors need to be considered in a food-based intervention. Vitamin A deficiency and chronic diseases, such as diabetes, heart disease and cancer, have become serious problems in the Federated States of Micronesia (FSM) following the decreased production and consumption of locally grown foods. However, agricultural and social conditions are still favourable for local food production. AIM: To identify key factors to consider in a Micronesian food-based intervention focusing on increased production and consumption of four major Micronesian staple foods: banana, breadfruit, giant swamp taro and pandanus. METHODS: Ethnographic methods including key informant interviews and a literature review. RESULTS: Pacific and Micronesian values, concepts of food and disease, and food classifications differ sharply from Western concepts. There are few FSM professionals with nutrition expertise. Traditional foods and food cultivars vary in nutrient content, consumption level, cost, availability, status, convenience in growing, storing and cooking, and organoleptic factors. CONCLUSIONS: A systematic consideration of the factors that relate to a food-based intervention is critical to its success. The evaluation of which food and cultivar of that food that might be most effectively promoted is also critical. Regional differences, for example FSM inter-island differences between the staple foods and cultivars, must be considered carefully. The evaluation framework presented here may be relevant to Pacific Island and other countries with similar foods where food-based interventions are being planned. An ethnographic approach was found to be essential in understanding the cultural context and in data collection and analysis.

Families and nursing home placements: a cross-cultural study.

With the aging of many populations, health care workers and families increasingly find themselves jointly involved in situations involving decisions about nursing home placements. How each approaches such situations is affected by beliefs and assumptions about the role of family members in the care of family members and the decision making process. This paper explores the responses of people from four cultural groups living in Australia (Anglo-Celtic Australian, Chinese, Greek, Lebanese) to a critical incident scenario about a Russian family in Australia faced with such a decision. The responses to this scenario were remarkably similar across the four cultural groups. All saw making such a decision as difficult, but the reasons for the difficulty suggest some interesting cross-cultural distinctions. Some groups viewed care of a family member more in terms of a social and role obligation while others addressed it as a personal responsibility. To not care for elderly parents in the home was accompanied by a sense of guilt among some respondents and a sense of public social shame among others. Ambivalence about nursing homes and placing a family member in a nursing home, culture change and cross-generational differences, and roles and role support were other important themes. The results are consistent with other data analysed in conjunction with the Intercultural Interaction Project. The findings from this research suggests a need to examine more closely the beliefs and assumptions associated with nursing home placements and one way to help students and health professionals to do so.

Rehabilitation services for the Pacific.

The Pacific Basin Rehabilitation Research and Training Center was created to help meet the challenges of rehabilitating people in rural remote communities in the United States-associated Pacific. We describe the center, the special region it serves, some of its many programs, and some of the ways it is helping communities in this region provide services that are appropriate and sensitive to the culture, the environment, and the disability.

Acculturation and symptoms: a comparative study of reported health symptoms in three Samoan communities.

A health questionnaire, which included a 91 item list of symptoms was administered to three groups of young Samoan adults. These young adults resided in a traditional Samoan village in Western Samoa (n = 50), several villages in modernizing American Samoa (n = 50) and in urban Honolulu, Hawaii (n = 52). Each yes response to a symptom was followed by an expanded interview providing details. The yes answer frequency and the contents of the expanded answers were examined with respect to site of residence. Western Samoan responses differed from the other sites in a number of areas suggesting possible differences related to the process of modernization. These response differences suggest four areas in which the stressors of modernization may have health influences: (1) wage employment outside of the family, (2) increased size of support networks by including non-family members and non-Samoans (3) the greater availability of alcohol, and (4) changes in the perceptions of food.

Is lactation nature's contraceptive? Data from Samoa.

Data from a Samoan menstruation study suggest that lactation, even intensive on-demand lactation, does not inhibit menstruation or conception. This paper explores the applied and theoretical implications of continuing to accept lactation as a universally effective fertility control mechanism. Such thinking can have disastrous implications for family planning programs, and it keeps us from challenging long-held assumptions about lactation's role in population growth in early populations.

PIP: An anthropologist analyzed 1986-87 data on lactating women from a rural village in western American Samoa to examine the link between lactation and ovulation suppression among non-Western, healthy, and robust populations. Most mothers practiced on demand exclusive breast feeding 24 hours/day for 4-5 months. Yet 75-80% resumed menses before the infant reached 3 months. A maternity nurse claimed that resumption of menses occurred in most mothers after 1 month and some women even deliver 2 infants in 1 year. The shortest postpartum amenorrheic period was 3 weeks and the longest was 14 months. Mean family size stood at 7.8. Birth intervals ranged from 1 to 3 years. These results indicated that the breast-feeding practices of these women were intensive enough to produce enough prolactin to suppress ovulation and suppress menstruation, but they did not do so. Apparently lactation was an ineffective contraceptive among these women. It is pointed out that considerable research shows lactation to be effective in malnourished women or those with low fat stores. yet these women ate the traditional high fat and nutritious diet. She stressed the need to reconsider the belief that lactation is a universally effective fertility control mechanism. She also emphasized the necessity to reeducate family planning workers that breast feeding does not necessarily suppress ovulation, especially in healthy and robust populations. These results have important implications for population growth and fertility control in modern as well as early population.

Rehabilitation technicians for remote rural communities.

A programme is described in which indigenous personnel are trained to provide culturally appropriate rehabilitation services for islanders of the Pacific Basin. The disabling conditions most commonly dealt with are associated with stroke, diabetes, arthritis, trauma, and back and neck pain. The programme could be adapted to meet needs in other remote rural communities lacking suitably trained carers.

The interplay of culture and symptoms: menstrual symptoms among Samoans.

Menstrual symptomatology has received much attention in recent years but little attention has been given to the interplay of culture with these symptoms. Interview data from male and female Samoans in rural Western Samoa, rapidly modernizing American Samoa, and modern Hawaii are used to explore the role of culture and culture change in explaining variations in reports of menstrual symptomatology and menstrual distress. I suggest that culture plays a significant role in the recognition, evaluation, and expression of menstrual symptoms, and thus culture must be considered along with biological and psychosocial variables in the evaluation of symptomatological differences, including differences in number and kind.

Modernization and catecholamine excretion of young Samoan adults.

Urinary catecholamine excretion rates have been used as a cross-culturally valid measure of generalized stress. The purposes of this paper are to examine group differences in catecholamine excretion rates in three Samoan groups who differ in degree of modernization and to compare these findings to rates of norepinephrine and epinephrine excretion in other populations. In 1986-1987, 24-hr urine samples were collected from 18-37-year-old Samoans; 46 rural Western Samoan villagers, 53 American Samoans, and 49 Samoans residing in Honolulu. The results show that norepinephrine excretion is significantly higher in more modernized Samoan groups (P less than 0.05), while epinephrine excretion is not significantly different in the three groups. The higher norepinephrine excretion rate in the more modernized Samoan groups may be related to differences in relative work load associated with changes in body weight, work capacity, and work patterns which accompany modernization. Samoan epinephrine excretion rates are relatively high compared to the results of other population studies, while norepinephrine excretion in three Samoan samples ranged from among the lowest rates observed worldwide to among the highest.

Selective migration from Samoa: a longitudinal study of pre-migration differences in social and psychological characteristics.

In 1981 extensive questionnaire and interview data were collected on some 100 young Samoan adults. Five years later in 1986 we determined their whereabouts and divided the data in accordance with migration status. The answers of the 35 who had migrated in the intervening period were contrasted to those 65 who remained in Samoa. The migrants differed in several distinct areas. Migrants reported a higher degree of peer-reliance as a personal adaptive strategy. Migrants also reported larger numbers of individuals in social support networks, a higher quality of support and more community involvement. They also report less expressive display of anger. Those who did not migrate reported a slightly better view of life in Samoa and abroad, as well as better relations with their friends and neighbors. These findings support a hypothesis that migrants are pre-selected to fit into migrant communities and do not appear to be misfits who are unhappy with life in Samoa.