Tau fifine Niue and the use of digital health tools: An intergenerational view

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Amio Matenga-Ikihele
Rosie Dobson
Fuafiva Fa'alau
Robyn Whittaker
Judith McCool


Pacific peoples, Niue women, health and wellbeing, digital health tools, mHealth, digital inclusion, digital health literacy


Introduction: Digital health technologies are rapidly changing the landscape of how healthcare is being delivered globally.Many international health systems are using digital technology to assist with delivery of information and  healthcare, to enable more affordable, accessible, and acceptable care to manage key health priorities pertaining to that population.  The key to success for any digital health approach for Pacific and ethnic-specific communities is ensuring digital inclusion is considered alongside the wider influences of health (family, cultural, economic, social, environmental). Digital technology could be the enabler to reduce inequities in health outcomes in  some populations.  The aim of this paper is to explore how an intergenerational group of tau fifine Niue (Niue women) use digital health tools for health and wellbeing.

Methods: Tutala, a culturally appropriate method of conversation with Niue communities (similar to talanoa in the Samoan language) was used to guide the research approach with a tau fifine Niue (n=40).  Six group tutala were undertaken with tau afine (young women), tau mamatua fifine (mothers), and tau mamatua tupuna fifine (older women).

Results: Three overarching themes were identified: (1) convenience of mHealth tools; (2) access to health information and resources; and (3) digital disconnection.  There were differences in the adoption and use of digital tools for health-related purposes, which varied from using the internet, text messaging and health monitoring apps.  Although tau afine and tau mamatua fifine were more likely to utilise digital health tools, it was clear not all tau mamatua tupuna fifine experienced the same benefits.

Conclusion: Supporting digital inclusion, digital skills, and digital health literacy for tau fifine Niue using an intergenerational approach can translate into health benefits for Niue families and communities. As more and more health services turn to digital technology to assist with delivering health information and care, it is critically important digital technology is delivered in an equitable way that benefits all people, including multi-ethnic populations in Aotearoa, New Zealand.

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1. World Health Organisation. mHealth: New horizons for health through mobile technologies: second global survey on eHealth. Report no. 3. Geneva. World Health Organisation. 2011.
2. Wilson B, Paunga H and Sharpe S. Telehealth as a mode of outpatient service delivery: A Pacific equity analysis. Auckland. Counties Manukau Health. 2021.
3. Gurney J, Fraser L, Ikihele A, Manderson J, Scott N and Robson B. Telehealth as a tool for equity: pros, cons and recommendations. New Zealand Medical Journal. 2021; 1341530: 111–115.
4. Thomas-Jacques T, Jamieson T and Shaw J. Telephone, video, equity and access in virtual care. NPJ Digital Medicine. 2021; 4159. DOI: https://doi.org/10.1038/s41746-021-00528-y.
5. Lyles CR, Wachter RM and Sarkar U. Focusing on digital health equity. JAMA. 2021; 32618: 1795–1796. DOI: 10.1001/jama.2021.18459.
6. Gann B. Transforming lives: Combating digital health inequality. IFLA Journal. 2019; 453: 187-198. DOI: 10.1177/0340035219845013.
7. Pacific Perspectives Limited. Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand. Wellington. Pacific Perspectives. 2019.
8. Ryan D, Southwick M, Teevale T, et al. Primary care for Pacific people. Wellington. Pacific Perspectives. 2011.
9. Southwick M, Kenealy T and Ryan D. Primary care for Pacific people: A Pacific and health systems approach. Wellington, New Zealand. Pacific Perspectives. 2012.
10. Department of Internal Affairs. The Digital Inclusion Blueprint, Te Mahere mō te Whakaurunga Matihiko. Wellington. Department of Internal Affairs. 2019.
11. Grimes A and White D. Digital Inclusion and Wellbeing in New Zealand. Motu Research. 2019.
12. Honeyman M, Maguire D, Evans H, et al. Digital technology and health inequalities: a scoping review.
13. Chesser A, Burke A, Reyes J and Rohrberg T. Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States. Informatics for health & social care. 2016; 411: 1-19. DOI: 10.3109/17538157.2014.948171.
14. Ehrari H, Tordrup L and Müller S. The digital divide in healthcare: A socio-cultural perspective of digital literacy. Proceedings of the Annual Hawaii International Conference on System Sciences. 2022. DOI: 10.24251/hicss.2022.499.
15. Norman CDSkinner HA. eHealth Literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research. 2006; 82: e9. DOI: 10.2196/jmir.8.2.e9.
16. Kim HXie B. Health literacy in the eHealth era: A systematic review of the literature. Patient Education and Counseling. 2017; 1006: 1073-1082. DOI: 10.1016/j.pec.2017.01.015.
17. Lee K, Hoti K, Hughes JD and Emmerton L. Dr Google and the consumer: A qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions. Journal of Medical Internet Research. 2014; 1612. DOI: 10.2196/jmir.3706.
18. Verbiest M, Borrell S, Dalhousie S, Tupa'i-Firestone R, Funaki T, Goodwin D, et al. A co-designed, culturally-tailored mHealth tool to support healthy lifestyles in Māori and Pasifika communities in New Zealand: Protocol for a cluster randomized controlled trial. JMIR Research Protocols. 2018; 78: e10789. DOI: 10.2196/10789.
19. Lee EW, Mccloud RF and Viswanath K. Designing effective eHealth interventions for underserved groups: Five lessons from a decade of eHealth intervention design and deployment. J Med Internet Res. 2022; 241. DOI: 10.2196/25419.
20. Vaioleti TM. Talanoa research methodology: A developing position on Pacific research. Waikato Journal of Education. 2006; 121. DOI: 10.15663/wje.v12i1.296.
21. Vilitama MJD. On becoming a liquid church: Singing the Niuean 'Fetuiaga Kerisiano' on a distant shore. Charles Sturt University, Australia, 2015.
22. Tavelia M, Kaue T, Sekene S, et al. Ko e fakatupuolamoui he tau magafaoa Niue: A Niuean conceptual framework for addressing family violence. Wellington. Ministry of Social Development. 2012.
23. Anonymous Flo: Track your health beyond periods., https://flo.health/ (2021).
24. New Zealand Health Information Technology. Hauora, Mauri Ora: Enabling a healthier Aotearoa New Zealand. New Zealand Health Information Technology. 2021.
25. Matenga-Ikihele AM. Let's talk about sex: Knowledge, attitudes and perceptions towards sexual health and sources of sexual health information among New Zealand born Niuean adolescent females living in Auckland. University of Auckland, 2012.
26. Sa'uLilo L, Tautolo E, Egli V and Smith M. Health literacy of Pacific mothers in New Zealand is associated with sociodemographic and non-communicable disease risk factors: surveys, focus groups and interviews. Pacific Health Dialog. 2018; 212: 65-70. DOI: 10.26635/phd.2018.914.
27. Digital Government NZ. Significant support needed for Pacific peoples to be digitally included, https://www.digital.govt.nz/news/significant-support-needed-for-pacific-peoples-to-be-digitally-included/ (2021, accessed 12.12. 2021).
28. Chopik WJ. The benefits of social technology use among older adults are mediated by reduced loneliness. Cyberpsychology, Behavior and Social Networking. 2016; 199: 551-556. DOI: 10.1089/cyber.2016.0151.
29. Pulotu-Endemann FK. Fonofale Model of Health. In: Anonymous. Wellington, New Zealand.