Tertiary institution’s duty of care for the health and well-being of Pacific students during COVID-19 pandemic: a cross sectional survey

Introduction

There has been increasing international interest in the health and wellbeing of students undertaking tertiary studies.^1–6 There may be expectations that the health and wellbeing of students attending university might be better than that of the general population. Contrary to this, there is increasing evidence that there are significant concerns about the health of students in higher education, particularly their mental health and wellbeing.^7–9 Additionally, the help and services that students are requiring support for have changed from minor ailments to more severe psychological problems.¹⁰ The COVID-19 pandemic is likely to have exacerbated these problems.^2,5,11,12

While there is increasing concern and recognition about the health and wellbeing needs of students in higher education internationally, there are relatively few studies that focus on access to support or feedback on how the support provided is received by students.^13–15 The COVID-19 pandemic highlighted further the concerns for student mental health and wellbeing needs.^2,5,12,16 There was a range of responses from institutions in response to the COVID-19 pandemic in G20 countries,¹⁷ some explored the reorientation of services through health promotion campaigns,¹⁸ while others developed changes in their systems and approaches.¹⁹

There is limited information in New Zealand about the health, wellbeing and services for students in higher education.^11,20–22 This is even more so for Pacific students.^23,24 The New Zealand Union of Student’s Association conducted a survey on the mental health of students in New Zealand in 2017.²⁵ Of the 1762 participants only 90 (5%) identified with a Pacific ethnicity. More than half (56%) considered dropping out of tertiary studies, some felt overwhelmed (28.2%), self-reported mental illness (20.2%) and had a fear of failure (17.3%). The mean Kessler 10 score was 28.1 (moderate level of distress). Research with first-year Pacific students at a New Zealand university showed 55% reported experiencing moderate to severe symptoms of psychological distress, depression and/or anxiety on standardised measures.²³ Two-thirds of those with poor mental health had sought assistance from professional support services on campus. Having a range of approaches to meeting the needs of students was recommended as being a helpful strategy. The aim of this research is to explore the role of one tertiary institution in the provision of support for Pacific tertiary students during the COVID-19 pandemic.

Methods

Pacific students’ perceptions of the support they received from the University of Otago during the COVID-19 pandemic were obtained from a cross-sectional survey conducted between April and June 2022. All Pacific students attending the University in 2022 were eligible to participate. An invitation to complete the survey was emailed to students. Eligible participants received three reminder emails during the data collection period. Pacific students from Otago Polytechnic were also invited to participate but were excluded from the analyses because of the very low response rate.

In addition to the usual support the University provides, students were also offered a health care pack at the beginning of the year. The contents of the health care pack included medical supplies and Pacific blessing cards. The main distribution site for health care packs was the Va’a o Tautai – Centre for Pacific Health at the University’s local campus. A number of smaller distribution sites were also available across the University. Students were directed to the distribution site that was closest to their location of study or accommodation. For students who were unwell or unable to pick up their health care packs at the local campus, the packs were delivered directly to their homes. For students who were located at other campuses, following confirmation of their addresses, the health care packs were posted to their home addresses.

The survey (for further details see Supplementary File S1) consisted of multi-choice questions including free text options and open-ended questions and took approximately 5 min to complete. Basic sociodemographic information was obtained, this included course of study, whether they had to self-isolate, support accessed and how helpful each type of support was for them rated on a four-point Likert scale. The survey responses were totalled for each question and summarised in frequency tables using descriptive statistics. The free text and open-ended questions were analysed to determine groups of ideas from the responses. These were further analysed to identify emerging themes from the data.

Ethics approval was granted by the University’s Human Ethics Committee (reference: D22/091) and standard University procedures for consultation with Māori were completed prior to commencing data collection. The information sheet about the survey, details about the survey responses being anonymised and contact details for support were included in the online forms before the online survey questions were presented. Informed consent was obtained before students were able to complete the online survey.

Results

There were 1277 Pacific students enrolled at the University in 2022 across different campuses that were eligible to participate. Of these students, 1068 (83%) were distributed a health care pack. Some did not respond to the invitation to receive a health care pack. Of all eligible Pacific students, 358 (28%) completed the survey. The sociodemographic details of students are summarised in Table 1. Most students (43%) were aged between 17 and 20 years and three quarters were female. Students were able to self-identify with as many ethnicities as they thought applied to them. Samoans made up nearly half of all those who identified with a Pacific ethnicity, Tongans and Cook Island Māori made up 18 and 16% respectively, Fijians (Indian and i-Tauke) made up 18 and Niuean 8%. Two students identified as indigenous Māori. Approximately one-quarter were in their first year and one-third in their fourth year of university studies, and half of all respondents were enrolled in a course within Health Sciences.

Three quarters of students had to isolate since the start of the academic year, either because they had COVID-19, or they were a close contact of someone with the disease. At least two-thirds had received support from the University, including support from Residential Colleges and academic departments. More than half accessed support from the Pacific Islands Centre and one-third through the Otago University Student Association. There were some (16%) who accessed support services from local Pacific health providers in addition to local communities and churches. The support accessed was valued by students who utilised these services. See Table 2 for a summary of support students accessed.

Of those who responded, most (99%) received a health pack, and of these 96% found it somewhat or very helpful. When asked ‘Can you share why you found this helpful?’ Student responses were categorised into themes as outlined below.

Discussion

This questionnaire survey describes Pacific students’ perceptions of the support they received from the University of Otago during the COVID-19 pandemic. Almost all students received a healthcare pack through the University P.O.P.O. (Pacific Opportunities and Programmes at Otago) programme and two-thirds received additional support through the University. Participants also highlighted a number of areas where the additional support helped them through written feedback.

Pacific peoples make up approximately 9% of the total New Zealand population and are over-represented in poor health and education outcomes.²⁷ The Pae Ora (Healthy Futures) Act 2022 (NZ) included the provision for a Pacific Health Strategy to improve health outcomes and workforce development.²⁸ Strengthening the Pacific health workforce is one of the priority areas for Pacific health improvement.²⁷ Addressing issues related to equity in the health workforce will contribute to improving health outcomes in society. The Ministry of Health’s definition of equity is ‘In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.’²⁹

Tertiary institutions in New Zealand can contribute to improving health outcomes and to apply the equity framework across all its programmes. A recent study in New Zealand focussing on tertiary institutions found that Māori and Pacific students had lower overall enrolments in the first year of study of health professional programmes.³⁰ The University of Auckland has established an Equity Office to lead its approach for an inclusive and equitable environment for students and staff.³¹ The University of Otago has both Māori and Pacific Strategic Frameworks outlining its commitment to the advancement of Māori and Pacific aspirations and educational outcomes.^32,33 In response to these, there are a number of support programmes to address equity issues for Māori and Pacific students.

The P.O.P.O. is a targeted programme for Pacific students undertaking courses and programmes within Health Sciences at the University of Otago. It is a partnership programme between the University of Otago and Ministry of Health (now Te Whatu Ora),³⁴ with components aligned with the Tinto’s model of institutional departure.³⁵ Tinto’s model places a specific importance on the role of institutions in supporting students to transition and remain at university. It highlights the importance of pre-entry attributes of incoming students and their level of preparedness for tertiary studies, the role of academic and social integration and the importance of students’ goals and intentions including institutional commitment for students’ success.³⁶

The P.O.P.O. programme has three components: popo (to start), pōpō (to nurture) and popō (to capture). Popo (to start) is about the incoming students, understanding who they are, their values and what is important to them, to enable them to thrive in the new learning environment. pōpō (to nurture) is about the responsibility of institutions to provide a nurturing environment for students to thrive. Lastly, popō (to capture) requires students to take responsibility to fully utilise the support that is provided to them for their benefit.

At the beginning of the academic year in 2022, the threat of the Omicron strain of COVID-19 resulted in a range of directives and restrictions from the New Zealand government to keep the community safe. Most Pacific students who attended the University of Otago were from out of town, and many decided to remain locally during this period. While this was a difficult time for everyone, existing systems and networks of support assisted in coordinating support for all students. Those who had financial difficulties could apply through Putea Tautoko for access to emergency resources. Other supports were provided through the Otago University Students’ Association, the Pacific Islands Centre and local Pacific community providers also contributed. The Va’a o Tautai – Centre for Pacific Health through its P.O.P.O. programme also organised support for all enrolled Pacific students through the offer of a health care pack. Pacific students really appreciated the range of support they were able to access through a range of providers, both internal and external to the University.

The situation during the COVID-19 pandemic gives an example of how institutions can provide leadership in working together with government and non-governmental organisations to support the health and wellbeing of students in tertiary institutions. Targeted support for minority students or those less likely to access support will ensure that students are less likely to fall through the gap. Student-led organisations also provide a helpful role for the wellbeing of all students in the tertiary environment.

Conclusion

Tertiary institutions are integral to the coordination of a whole of community approach in the provision of support for students. This research shows that tertiary institutions can provide effective leadership in the coordination and provision of support for the health and wellbeing of their students through working together with student-led, government and non-governmental organisations in the community.

Supplementary material

Supplementary material is available online.