Mahaki hela: the asthma-related ideas, home interactions and diurnal cortisol patterns of 3-4 year-old New Zealand Tongan and Pālangi children with asthma

Abstract

This dissertation presents two complementary studies of Tongan and Pālangi (New Zealand-European) three and four year-old children's family relationships. Both studies investigated the culturally specific nature of young children's everyday experiences and family relationships, and refined a child-focussed, cross-cultural collaborative method. Participants' ideas provided the basis for interpreting behavioural patterns derived from videotaped observations of children's interactions with adults and siblings in their New Zealand homes. The first study compared healthy Tongan (N=5) and Pālangi (N=5) children's interactions with adults and siblings. Tongan children's interactional patterns with adults and siblings were similar. Pālangi child-adult exchanges involved more behaviours than child-sibling interactions. Direct comparisons of Tongan and Pālangi child-adult interactions indicated that Pālangi exchanges were more verbal and children were more successful at eliciting ongoing interactions than Tongan children were, reflecting adult caregivers' expectations of appropriate behaviour. Pālangi children had more opportunities to develop interactional patterns that are valued by the dominant cultural group and are rewarded in New Zealand schools. The second study of children with asthma combined ethnographic, ethological and biological approaches to determine the asthma-related ideas, and to compare behavioural and salivary cortisol patterns of Tongan (N=5) and Pālangi (N=5) children on asthma and remission days. Children contributed to refining methods of data collection and interpreting their relationships. Children disclosed early asthma symptoms that were not always apparent to their caregivers. Tongan and Pālangi child-adult interactions differed irrespective of asthma phase, following a similar pattern to the first study. Pālangi child-adult interactions were more frequent and more verbal compared to Tongan child-adult exchanges. Children co-operated with adults less often on asthma versus remission days, with Tongan children reducing co-operative behaviours more than Pālangi children did. Child-sibling interactions were generally similar for Tongan and Pālangi children, irrespective of asthma phase. During asthma phases, child-sibling interactions tended to be shorter and involve fewer overall behaviours than during remission. Children tended to direct fewer co-operative behaviours to siblings. When children had asthma, siblings made fewer demands of children, tended to be less aggressive and to initiate fewer interactions compared to remission. The cortisol patterns of Tongan and Pālangi children and their asthma-free siblings changed in different ways during asthma phases, with Tongan children showing lower cortisol values on awakening compared to remission. These preliminary findings suggest that young children and family members adapted to asthma exacerbations differently; well siblings made more behavioural adjustments than either adults or children with asthma and Tongan but not Pālangi children had dampened cortisol profiles. Tongan children's reduced co-operation with adults during asthma phases supports the Tongan focus on relational components of health. Specifically, definitions of health incorporate an ability to meet social obligations, which include co-operative behaviours that demonstrate recognition of, and response to, the needs of others. Key words: cross-cultural; inter-disciplinary; child-focussed; Tongan; Pālangi; preschool; asthma; ethnography; behaviour; salivary cortisol; development.