Investigating factors that influence success of Pacific students in first-year health sciences at university in New Zealand

Pacific peoples living in New Zealand, a migrant ethnic group make up approximately 7% of the total population.1 Since the 1960s, increasing numbers migrated to New Zealand from different islands in the Pacific for better employment and educational opportunities.2-4The Pacific population however is over-represented in poor health statistics and socioeconomic determinants of health when compared to the total population.1,5 Pacific peoples share many concerning socioeconomic factors which influence health with M ori, the indigenous people of New Zealand.6Education is an important determinant of health.7 In recent times there has been some improvement in education outcomes for M ori students; however, concerning trends remain unchanged for Pacific students.8 For example, completion rates for Pacific students in tertiary education was lower than all other ethnic groups, including M ori.8The issues involved are complex and influenced by student development and preparation prior to university,9 transition and experiences at university10 and socioeconomic and cultural factors.7 In response to these concerns, the New Zealand Government outlined Pacific plans to improve health and education outcomes for Pacific peoples.11,12 Increasing the number of Pacific peoples successfully completing health education training will contribute to improving outcomes, and provide a diverse workforce for a multi-ethnic society in New Zealand.Pacific health professionals make up 1% of doctors, 2.8% nurses, 0.7% physiotherapists, 0.5% dentists, and 0.2% pharmacists in the New Zealand health workforce.13 A government strategy to addressing disparities included improving educational achievements, and Tertiary Education Institutions are expected to be part of the solution.14The University of Otago has four academic Divisions with 21,780 enrolled students in 2010. The Division of Health Sciences is the largest provider of health education and professional training in New Zealand. It has the first established medical school in New Zealand, the sole training site for dentists, provides training in physiotherapy, pharmacy, oral health, medical laboratory science, bio-medical science and radiation therapy. In 2010, there were 4702 students enrolled in the Division. Of these, 163 (3.5%) self-identified as Pacific students.Students who wish to enter a health professional course at the University of Otago are required to enrol in the competitive HSFY course.15 The academic requirements for entry into a health professional course varies across different programmes within the Division.16 Some health professional courses have Affirmative Action Programmes for minority groups, which seek to increase the entry of students from under-represented minorities. Similar programmes are offered in the USA and UK universities.17,18The number of Pacific students successful in entering health professional courses following the HSFY course however is low, and numbers have not increased over the past decade.19Previous studies have outlined the importance of the cfirst-year experienced for students in Universities.20,21 Many tertiary institutions in the USA, UK and more recently in Australasia have used national student surveys focussing on cstudent engagementd to identify areas associated with successful academic outcomes.22-24 cEngagementd is the extent to which students devote to educationally purposeful activities and the policies and practices that institutions use to encourage students to take part in these activities.21, 24, 25These surveys found a supportive campus environment, good staff-student and student-student interactions, high level of academic challenge, collaborative learning environment and enriching educational experiences were linked to successful academic outcomes for students.Research in the USA however have often grouped students from the Pacific Islands and those from Asian countries together,20 and a recent Australasian study provided very limited information on Pacific students and cengagementd in New Zealand.24 There has been some research and work in New Zealand on tertiary education for Pacific peoples in New Zealand,26-29 however none of these has focussed specifically on first year health sciences at tertiary level.We conducted this research with the aim to understand cengagementd, transition and adjustment to university for Pacific health sciences students in their first year of study, and investigate the relationship between these and academic outcomes.Methods Students who identified with a Pacific Island ethnicity at registration and enrolled in the HSFY programme at the University of Otago in 2010 were eligible to participate. Pacific students were identified from the Division of Health Sciences database and recruited mid-way through the first semester over six weeks. Recruitment started on 24 April 2010. A message was sent from the Associate Dean (Pacific) by e-mail to all eligible students, explaining the purpose of the survey and inviting everyone to participate. Students were recruited by Pacific research assistants during a Pacific HSFY student forum. Those who participated went into a draw for a raffle to win prizes (valued at $150, $100, and $50). A small gift was offered to students who completed the questionnaire at later events during lunch hours, and after tutorials offered by the Pacific Islands Centre. In the final week of the survey, remaining students were contacted through mobile phone and offered the opportunity to participate. All students who agreed to participate were given information sheets outlining the aims of the research and contact details if they had further questions. Ethical approval was obtained from the University of Otago Human Ethics Committee at the departmental level. The questionnaire obtained information about students socio-demographic background, career choice, transition and adjustment to the University environment, study skills, perception of learning, engagement with peers, and use of existing support networks. Responses consisted of a five-point Likert rating scale (ranging from 1=Strongly disagree to 5=Strongly agree). Other response scales included: cNot very welld to cVery welld and cNot very closed to cVery closed. Data from the questionnaires were entered into an excel sheet. Results from first semester exams and successful entries into health professional programmes at the end of the year for all students were obtained. Data were analysed using SPSS statistical software. Results Sixty-six students were identified as Pacific from the Division of Health Sciences database. Eleven students enrolled online at the beginning of the year, but did not attend university and were excluded. Six Pacific Island students completed the questionnaire, but were not on our original database. Of the 61 students who were eligible to participate, 55 completed the survey, one declined, and five could not be contacted, giving a response rate of 90%. Of the 55 participants, 60% passed all papers and 40% failed one or more papers from the first semester exams. Of the 61 Pacific students who enrolled in the HSFY course in 2010, 14 (20%) were successful in getting into a health professional course in 2011. Five in physiotherapy, four in medicine, three in pharmacy and two in dentistry. Baseline demographic details are presented in Table 1. The majority of students (96%) had parents who lived outside the university city area. Most students (63.5%) lived in a residential college/hall, 21.8% flatting situation, 9.1% with parents/relatives, and 5.5% in other living arrangements. Ninety one per cent of students entered university directly from high school. Most students (73%) indicated a preference for studying medicine if they were successful in their HSFY course. Fifteen per cent indicated a preference for dentistry, 6% physiotherapy and 6% a range of other health courses. Most (85%) preferred to stay within the health sector as a career pathway, even if they did not succeed the following year in getting into their preferred health course. Of these, some preferred to complete a degree and apply again to their preferred course through the graduate entry pathway, others indicated they would train in a different health area. Table 1. Demographic characteristics of Pacific students enrolled in Health Sciences First Year (HSFY) Demography of study participants n (%) Age group (years) 16-19 20-24 25-29 30-49 45 (81.8) 7 (12.7) 2 (3.6) 1 (1.8) Gender Female Male 35 (63.6) 20 (36.4) Ethnicity Samoan Cook Islands (M ori) Tongan Niuean Fijian Indigenous Fijian Indian Tokelauan Other Pacific ethnicity Did not respond 12 (25.5) 4 (7.3) 9 (16.4) 0 (0.0) 4 (7.3) 22 (40.0) 1 (1.8) 1 (1.8) 2 (0.0) Languages spoken English only English plus Indigenous language English plus Indian language English and non-PI language Did not respond 20 (37.0) 17 (31.5) 15 (27.8) 2 (3.7) 1 (0.0) Table 2 shows five areas which describe the cfirst year experienced of Pacific students at the University of Otago. Most students reported satisfaction with their transition into university life, felt the campus environment was supportive and positive, integrated well with their peers and developed friendships, received good academic support, and sought or felt able to seek assistance for their studies. One-quarter struggled with the course, 22% were not coping with the academic workload, and 18% felt the workload was not what they expected it to be. Table 3 shows study skills of participants and academic performance in the first semester exams. Most students felt they were able to get help for their academic courses when needed, work independently, and had developed good study skills. Half of those who failed a paper cagree/strongly agreed they had developed good study skills. Students who passed all papers were more likely to cagree/strongly agreed they cfeel confident to approach lecturers for advice and assistanced than those who failed a paper. This result was statistically significant. Table 2. The experiences of Pacific students in HSFY Variables Disagree/Strongly Disagree Somewhat Agree Agree/Strongly Agree 1 to 2 n (%) 3 n (%) 4 to 5 n (%) Transition to University I was well prepared for University by my previous education experience 6(11) 18(33) 31(56) Study at University was what I expected it to be 10(18) 12(22) 33(60) I am confident doing HSFY was the right decision 1(2) 10(18) 44(80) I am enjoying my course very much 4(7) 12(22) 39(71) I feel lonely most of the time since arriving at University 44(80) 8(15) 3(5) I am seriously considering dropping out of University 54(98) 1(2) Overall I am happy with my experiences at the University of Otago 1(2) 6(11) 48(87) Campus Environment I think the University of Otago as a whole takes an interest in student welfare 3(5) 11(20) 41(75) I really enjoy organised Pacific student events* 4(8) 15(28) 34(64) My academic experiences at University so far has been positive 1(2) 20(36) 34(62) The University of Otago is not providing enough support for the social and cultural needs of Pacific students 39(71) 8(15) 8(15) Peer Engagement I have made a lot of friends 2(4) 3(6) 50(91) I usually 8hang out mostly with Pacific students 33(60) 4(7) 13(33) I am ok with 8hanging out with students from different ethnic backgrounds 3(5) 1(2) 51(93) I discuss my work with other students studying the same subject 2(4) 5(9) 48(87) Staff-Student engagement The University of Otago provides good academic support for Pacific students 0 6(11) 49(89) Academic staff make it clear what is expected of us 4(7) 14(26) 37(67) I am able to get help for my academic course when I need it 1(2) 7(13) 47(75) I feel confident to approach lecturers for advice and assistance 14(25) 11(20) 30(55) Academic Challenge The workload is what I expected it to be 10(18) 15(27) 30(55%) I am having difficulty with most of the material in the course 22(40) 19(35) 14(25) I have regularly sought extra help for my studies\u2020 7(13) 14(26) \r\n\