title: The pre-hospital experiences of Samoan families who have had a child admitted to hospital with pneumonia: a qualitative investigation.
abstract: OBJECTIVE
  The aims of this investigation were to describe the pre-hospital experiences; health actions and attitudes towards health services of Samoan families who have had a child hospitalised with pneumonia. This information will inform policy makers, health professionals and the Samoan community in order for them to improve and create health care services that are appropriate for Samoan families.
  
  
  METHODS
  Twelve Samoan families, each with a child admitted to the Starship Children's Hospital with pneumonia, were interviewed in an open-ended in-depth interview style. Interviews lasted thirty to forty-five minutes and were undertaken in the preferred language of the caregiver (English or Samoan).
  
  
  RESULTS
  For most caregivers continuity of care in the community was poor. Reasons for this included structural and personal barriers to health care services and mistrust of doctors. Mistrust influenced caregivers to go elsewhere for care and therefore care became fragmented. The theory of delayed presentation was not supported. Caregivers were quick to act on symptoms and behaviours that they believed were different from normal and worse than non-urgent symptoms. Those who 'self-referred' to the hospital had in fact visited a doctor in the community at least once prior to admission. They had then made their own decision to present to the hospital. Reasons for self-referral included mistrust of health professionals in the community and structural and personal barriers to services. A break down in communication between caregivers and health professionals was an important personal barrier to services. Caregivers did not feel that pneumonia was an appropriate illness to be treated solely with traditional methods. Caregivers who consulted traditional practitioners had also consulted at least one doctor in the community.
  
  
  CONCLUSIONS
  Although Pacific children are less likely than other children to present to the emergency department with the documentation from a general practitioner, in many cases they have been to see one. A lack of continuity of care was caused by a break down in communication between the caregiver and the health professional rather than there being an inability by caregivers to recognise the symptoms of pneumonia and therefore a delay in presentation. This breakdown in communication could be one explanation for the differences in illness severity and hospitalisation for pneumonia among children in different ethnic groups. Considering their reasons for doing so, caregivers who self-referred attended the emergency department appropriately. The use of traditional health methods did not impair access to Western medicine for these children with pneumonia.
authors.affiliation: Auckland District Health Board, Public Health Protection, Private Bag 92605, Symonds Street, Auckland, New Zealand. nyoung@adhb.govt.nz
authors.forename: N
authors.initials: N
authors.lastname: Young
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005190:Family / Q000208:ethnology*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010817:Physician-Patient Relations; D011014:Pneumonia / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D011320:Primary Health Care / Q000592:standards*; D018947:Samoa / Q000208:ethnology