The Impact of Student-led Community Health Screenings on Clients’ Health Knowledge and Outcomes: A Qualitative Study in New Zealand
Article information
Abstract
Objectives
This study investigated the impact of community health screenings (CHS) on the Asian community, focussing on the role of a student-led health and wellness centre in promoting and improving health outcomes. The CHS is a collaboration between Te Kotahi Oranga | Health and Wellness Centre and The Asian Network Incorporated, offering free health screenings to Asian migrants in the Waikato region, New Zealand.
Methods
Employing a qualitative approach, we interviewed clients who participated in the CHS to determine their perceptions regarding the effectiveness of the programme, its influence on their health knowledge and actions, and their overall satisfaction with the service. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study.
Results
Data analysis utilising reflexive thematic analysis yielded 5 themes: satisfaction and appreciation for the free health screening; strengthened commitment to better personal health; barriers and challenges in accessing public healthcare services; improved knowledge and awareness of health risks; and provision of more health screening tests and health seminars. The findings highlight the significance of culturally tailored health initiatives in addressing healthcare disparities, emphasising the need for innovative strategies to ensure continuity of care and support for underserved populations.
Conclusions
This research contributes to the understanding of how student-led health interventions can enhance public health efforts and improve health outcomes in Asian and migrant communities.
INTRODUCTION
In Aotearoa New Zealand, the term “Asian” is an ethnic category in official statistics that includes people from East Asia, South Asia, and Southeast Asia. The Asian population has grown substantially, increasing by 21.8% to 861 576 people since 2018, now representing 17.3% of the overall population, according to the 2023 census [1]. The increasing Asian and migrant population experiences challenges in accessing public healthcare due to language barriers, cultural disparities, and a lack of culturally appropriate services [2–4]. Many Asian migrants struggle to navigate the healthcare system, facing stress, miscommunication, and hesitancy to seek care due to limited translated materials and culturally competent providers [2,5]. Addressing these challenges requires targeted interventions such as improved language support, cultural competency training, and tailored public health communication for Asian communities [5,6].
In response to these challenges, Te Kotahi Oranga (TKO), a student-led health and wellness centre at Waikato Institute of Technology (Wintec) Hamilton, New Zealand, has designed and implemented a free community health screening (CHS) programme as part of the students’ clinical placement activities. As a student-led centre, TKO operates as a supervised environment where students provide clinical services to underserved communities. This centre facilitates the development of various skills, including clinical practice, communication, leadership, and teamwork, by allowing students to engage with real patients [7]. CHS is considered an essential public health strategy that can enhance population health awareness and facilitate early detection of disease [8,9]. CHS is particularly valuable for individuals with limited access to healthcare, offering them opportunities to learn about health risks, undergo medical tests, and interact with healthcare professionals [8,9]. Participation in CHS has been shown to improve participants’ health knowledge by providing personalised health information tailored to individual needs [10]. The positive impacts of CHS underscore its growing importance in addressing healthcare disparities and promoting public health awareness [11]. A programme logic model (Figure 1) provides a systematic framework of programme conception, execution, and assessment, ensuring alignment with its objectives and the potential to significantly impact community health outcomes.
Programme logic for Te Kotahi Oranga community health screening development.
TKO formed a partnership with The Asian Network Incorporated (TANI), a not-for-profit organisation that works to support Asian health and well-being through networking and identifying opportunities for collaborations, to provide free health services to the Asian and migrant communities in the Waikato region. Screenings were conducted weekly at the TANI Hamilton office, primarily serving clients aged 45 and above from Chinese and Korean backgrounds. Promotion was carried out through online platforms used by members of these ethnic groups, leveraging the network and trust that the office’s Korean and Chinese staff members had established within their communities through their personal and professional experiences. TKO CHS included a blood glucose test (pre-diabetes check) and cardiovascular risk assessment (CVRA). The CVRA included glycated haemoglobin and lipid tests using the Cobas B101 (Roche Diagnostics GmbH, Mannheim, Germany) machine, a blood pressure check, and measurements of waist circumference, weight, and height. They were conducted by student nurses and occupational therapists under the supervision of registered healthcare professionals. The process involved a brief initial consultation, followed by targeted medical tests. The results were discussed immediately after the screenings, allowing participants to understand their health risks and receive advice on necessary follow-ups. In this study, we explored the participants’ experiences to understand how the programme impacted their health knowledge and health conditions. This research was designed as part of our ongoing efforts to evaluate the programme’s outcomes and identify areas for improvement to increase the effectiveness of TKO CHS to better serve the needs of our community. The following questions guided our research: (1) How do participants’ expectations, motivations, and overall satisfaction with the health screening influence their engagement and the potential impact on their health outcomes? (2) Does participating in the health screening lead to the early detection of health issues for participants, and how does this knowledge inform their health decisions?
METHODS
Study Design
For an in-depth exploration, this study employed a qualitative research design to evaluate the experiences and impacts of the TKO-TANI CHS programme on Chinese and Korean participants in Hamilton, New Zealand. We conducted semi-structured interviews to gain insights into their perspectives and to understand the programme’s effectiveness in improving health knowledge and outcomes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) [12] checklist was used as a guide in reporting this study.
Participants
Purposive sampling was used to select the participants. There was no restriction on the target number of participants, but we eventually interviewed 9, with data saturation determining the endpoint [13]. They comprised 6 Chinese and 3 Korean clients who attended one of the CHS in TANI Hamilton office. The participants were seen by our student nurses and occupational therapists under the supervision of TKO staff members who were registered health professionals for the CVRA and (pre)-diabetes check. Recruitment for interviews was based on individuals’ willingness to discuss their experiences during the health screening, ability to attend the interview at the scheduled time and place, ability to communicate their thoughts, experiences, and feedback, and we also prioritised recruiting individuals who had presented with health conditions or concerns that were addressed during the screenings. Additionally, it included some participants who had been advised to seek immediate appointments and consultations with their general practitioners (GPs) due to their existing medical conditions. Participants’ background and health screening outcomes are summarised in Tables 1 and 2.
Participants’ demography and health screening results
Data from health screening
Data Collection: Semi-structured Interviews
We opted for individual face-to-face semi-structured interviews to maintain confidentiality, given the expectation that participants would disclose personal health information, lifestyle choices, and concerns [14]. Prior to formal data collection, JRY (TKO Operations and Research Coordinator, PhD), WZ (TANI Community Engagement Coordinator, MA) and SP (TANI Community Engagement Manager, PhD) piloted questions with non-participating clients to refine the interview questions and process based on their feedback and recommendations. To ensure consistency, a training session and practice run were organised for the 3 interviewers, with input from TKO staff members. Data collection commenced once these preparatory steps were finalised. WZ and SP initiated participant recruitment by contacting the participants through instant messaging platforms (WeChat and Kakao Talk) and phones and scheduling interview sessions at a venue of their choice. Each interview, lasting a maximum of 60 minutes, facilitated detailed discussions. SP conducted interviews with Korean participants at the TANI Hamilton office, while JRY and WZ interviewed the Chinese participants at their respective residence. Interview questions, tailored to the research objectives and research questions were administered in the participants’ preferred language (Mandarin or Korean). All interviews were audio-recorded and transcribed verbatim. We shared a copy of the Korean/Chinese transcript with the participants, inviting them to review it for accuracy and provide comments or corrections. JRY, WZ, and SP then performed double translations of the checked transcripts from Chinese/Korean to English and vice versa to ensure the reliability of the data, before coding it in English for thematic analysis. Data collection continued until we reached data saturation, where no new information or themes were found in the data, thus completing the process. Microsoft Word and Excel (Microsoft, Redmond, WA, USA) was used to code and categorise data.
Statistical Analysis
The data analysis procedure followed the 6-phase reflexive thematic analysis framework outlined by Braun and Clarke (Figure 2) [15,16]. First, familiarisation with the data involved immersing ourselves (JRY and WZ) in the interview transcripts to gain a comprehensive understanding of the content. Next, initial codes were generated by systematically identifying meaningful segments of data related to the research objectives and questions. These codes were then organised into potential themes, grouping together codes that shared similar meanings or concepts. Subsequently, JRY and WZ reviewed and refined these themes, ensuring they accurately reflected the data and provided coherent insights. Once the themes were finalised, JRY and WZ defined and named each theme to capture its essence succinctly. Finally, the themes were integrated into a coherent narrative, supported by illustrative quotations from the data, to convey the richness and complexity of participants’ experiences and perspectives.
We further enhanced the trustworthiness of our data analysis by incorporating the criteria outlined by Nowell et al. [17]. First, we ensured credibility by employing 2 coders (JRY and WZ) to independently analyse the data and compare their interpretations to reach consensus on the emerging themes. This iterative process allowed for a thorough examination of the data from diverse perspectives, minimising individual biases and increasing the reliability of our findings. Additionally, we promoted dependability by maintaining detailed documentation of our analytical decisions, including code development, theme generation, and revision processes. This transparency facilitated the replication of our analysis and provided a clear trail of our methodological approach. By continuously reflecting on our role as researchers and considering alternative explanations for the data, we mitigated the risk of subjective bias and strengthened the objectivity of our analysis.
Ethics Statement
This study was approved by Wintec | Te Pūkenga’s Ethics Committee (approval No. WTFE10111022). All participants were briefed on the objectives of the research and their rights and provided written consent to participate in the health screening and interview. To prevent potential conflicts of interest, participants were not employees or family members of TKO or TANI or involved in the screenings’ administration. In compliance with ethical requirements the conventions of confidentiality and anonymity were respected.
RESULTS
The implementation of the TKO CHS programme yielded several positive outcomes for the clients and highlighted critical areas for improvement in public healthcare access. The reflexive thematic analysis yielded 5 themes: satisfaction and appreciation for the free health screening; strengthened commitment to better personal health; barriers and challenges in accessing public healthcare services; improved knowledge and awareness of health risks; and provision of more health screening tests and health seminars. Noteworthily, the themes derived from the interviews align with the programme’s expected key outcomes (Figure 1), demonstrating consistency between the TKO CHS objectives and its actual outcomes. A summary of the findings (themes and subthemes) is presented in Figure 3, followed by elaborations supported by excerpts from the interviews with the participants.
Themes and subthemes identified from the participants’ health screening outcomes and experience. GP, general practitioner.
The participants expressed high satisfaction and appreciation for the programme, citing the provision of accessible and free basic health checks and immediate access to results and follow-up explanations. They commended the efficiency and friendliness of the staff and students, and the efficiency of scheduling and appointment management:
“I think your examination was well conducted. I got to experience firsthand how the tests were done, like the blood draws and getting the results quickly. The two test results (from the GP and TKO CHS) were pretty consistent. So, I thought it was really good. I’ve been telling my friends that this health screening program is really good and very convenient. You can tailor it to your own schedule, pick a time that works for you, and just come in. The staff are all friendly and helpful. Overall, the screening went really well, and my friends are interested too (P1, Female).”
“In a place like New Zealand, we feel that as immigrants, we can truly receive quality care, particularly from organisations like yours. For individuals above fifty, well, we’re over 65, being able to access such care and attention fills us with immense joy, warmth, and gratitude. Naturally, we sincerely hope that this programme continues, as we understand it might face challenges due to current constraints on medical resources from our point of view (P2, Male).”
“I found that during my last health check-up, the service was top-notch. Everyone was really friendly and approachable. As for the tests they conducted, I was especially impressed with the blood tests. The results came back straightaway, which I found very efficient. So, I found the whole process of this basic health check satisfactory (P6, Female).”
The screenings also resulted in a heightened commitment to personal health. Participants reported increased awareness of lifestyle factors affecting health outcomes, making notable changes in diet and exercise routines post-screening, and a strong willingness to follow-up on health screening results and recommendations. There was also a marked increase in the awareness of personal responsibility in health management:
“I went for my check-up appointment as scheduled. It was quick and right on time. Previously, I wasn’t aware that my blood pressure and blood sugar were high. So, it’s good to get a reminder, isn’t it? Also, back then, I weighed over 85 kg. But now, I’ve shed about 7 or 8 kg, so I’m around 80. During the screening, they gave me some suggestions, like increasing exercise and keeping an eye on my diet. Nowadays, I stick to just two meals a day (P5, Male).”
“This was the first time I heard that my cholesterol was high. I found out for the first time here that my cholesterol was high after this test. So now, I’m trying to eat more vegetables and reduce my intake of carbohydrates and meat for the sake of my health. Consequently, I’ve lost a significant amount of weight since adopting a primarily vegetable-based diet (P8, Male).”
Participants also demonstrated improved knowledge and awareness of health risks, recognising the importance of early detection and intervention, understanding the severity of previous health issues, and becoming more aware of personal health risks and preventive measures. There was an increased awareness of the importance of regular health check-ups:
“Your programme is very helpful. Honestly, if it wasn’t for your reminder, I probably wouldn’t have bothered with a check-up with my GP. I usually just tough it out and get over things. That’s been my mindset, but this time around, I’m really thankful to you for pushing me to get checked. Turns out, I was anaemic and low on iron. Initially, I was just feeling dizzy and experiencing leg cramps. I figured it was just a typical age-related thing, but I never expected it to be due to iron and blood deficiency. I thought maybe my legs were just cold or tired, leading to the cramps. You know how it is with us older folks, we tend to brush things off like that - ‘oh, just getting old, dealing with cramps’ - that sort of mindset. So, I didn’t take it too seriously at first (P3; Female).”
“Since I’m not an expert, I have assessed myself based on the medical knowledge I knew and the information available on the internet. I thought I was at risk for diabetes. However, when I received the test results, there was a registered nurse at that time, and based on their expert opinion, they said there was no need to worry so much. They reassured me that if I manage better, my health will definitely improve, and it will return to normal levels. So, I didn’t have to worry too much, and I felt really relieved. I have a very positive memory of the health check-up and due to that experience, I became more conscious of my eating habits, and it’s had a good impact on me (P7, Male).”
However, the study also identified significant barriers and challenges in accessing public healthcare services. Delays in scheduling appointments, time constraints associated with GP visits, language barriers, and a limited understanding of the healthcare system in New Zealand were cited as major obstacles:
“I’ve always been a bit wary of my GP, you know? During my last visit, she rushed through appointments and didn’t even prescribe me anything, just told me to buy some iron tablets myself from the pharmacy. That’s why I tend to avoid her unless things get dire and there’s no other option (P3, Female).”
“Over here [in New Zealand], even though seeing a GP is free, it’s not easy to get a comprehensive check-up like you would back in your home country, no matter if you’re willing to pay or not. It’s a bit more complicated here, especially with the language barrier and all. You have to go through a GP who then arranges the check-up for you. You can only get the check-up if they recommend it, and you’re limited to the tests they prescribe. If you ask for something else, they might not agree or consider your request. That’s something many Chinese people worry about (P5, Male).”
Finally, the results underscore the need for more comprehensive health screening tests and health seminars. Suggestions from the participants included providing more tests for early detection and prevention of diseases, increased promotion and marketing of the programme to boost community participation, and the organisation of targeted health talks:
“The main thing is this health check, it’s basically just a blood test at the moment. If you wanted to check anything else, well, that service isn’t available right now. I just hope they can expand it to include more checks for common diseases (P3, Male).”
“…For instance, there could be seminars tailored for middle-aged to elderly individuals, focusing on topics like blood pressure and cardiovascular issues. It’s really beneficial because as people age, these issues tend to arise gradually. Elderly individuals are often quite concerned, especially since they may already have developed hypertension, and we’re still in this transitional phase. And also, things like, what symptoms or signs should you be looking out for? That’s when you should see a doctor. I feel like in Chinese culture, we don’t really visit the doctor much. We tend to tough it out and hope it passes (P6, Female).”
DISCUSSION
This study sought to gain a deeper understanding of participants’ experiences during health screenings and to assess the impact of the screenings on participants’ health knowledge. It further explored the role of student-led CHS in promoting better health outcomes. The findings highlight 3 key areas.
First, participants’ engagement with the health screening services was influenced by their expectations and motivations. High levels of satisfaction were reported, particularly due to easy access to basic health checks and results, as well as the efficiency and friendliness of staff and students. These factors determined participants’ willingness to engage with the health services offered, demonstrating the importance of positive patient experiences in fostering continued health service utilisation [5,11,18]. Motivations for participating in the screenings often stemmed from a desire to understand and manage personal health better [19]. Awareness of lifestyle factors affecting health outcomes and subsequent changes in diet and exercise routines post-screening indicate a heightened commitment to personal health management. These findings support Bandura [20,21]’s social cognitive theory, which suggests that increased knowledge and self-belief can drive behaviour change. Moreover, Jepson et al. [22] and Teyhen et al. [23] have argued that health interventions promoting personal responsibility are effective in sustaining long-term health behaviour changes.
Second, TKO CHS contributed to the early detection of health issues for many participants, echoing studies [8,10,24] that reported the benefits of CHS in reducing the incidence and severity of chronic diseases. Participants who became aware of their health risks reported increased willingness to follow-up on health screening results and recommendations, reflecting an informed approach to health management. Early detection and intervention can significantly alter health trajectories by enabling the timely and effective management of health issues [25]. The improved knowledge and awareness of health risks among participants further underscore the role of health education in preventative care and TKO CHS as a platform for health promotion. Moreover, the recognition of the importance of regular health check-ups and the realisation of the severity of previous health issues underscore the need for ongoing health monitoring and education. This suggests that health promotion through CHS can encourage proactive health behaviours and improve long-term health outcomes for the targeted population health [26,27].
Third, this study identified barriers to accessing public healthcare services, such as delays in scheduling appointments, language barriers, and a limited understanding of the New Zealand healthcare system, which highlight the potential deterrents to healthcare delivery [28]. Student-led health and wellness services/centres may contribute to addressing these barriers to help ensure equitable access to healthcare and improve overall public health [29,30]. The participants provided several recommendations for future improvements of the TKO CHS programme, including expanding the range of health screening tests and organising targeted health seminars that can enhance preventative care. Additionally, increased promotion and marketing of the TKO CHS programme are essential to boost community participation and engagement.
Taken together, student-led health services may be purposefully engaged to conduct health promotional activities that may lead to better public health outcomes. The encouraging reception and concerns raised support an expanded screening service (in collaboration with NGOs and community-based organisations [31]), offering targeted health education, and improving programme promotion to ensure broader community engagement and better preventative care.
To summarise, the growing Asian and migrant population in Aotearoa New Zealand faces ongoing barriers to healthcare access, including language difficulties, unfamiliarity with the local healthcare system, and limited consultation time with GPs. The outcomes of the TKO CHS programme suggest that student-led initiatives can help mitigate some of these challenges by providing culturally competent care, offering clear explanations of screening results and medical terminology with interpreter support, and fostering strong client relationships. Future programme improvements and research should focus on empirically measuring the long-term health impact of CHS in a student-led healthcare setting. Additionally, exploring the integration of technology, such as mobile health apps, could enhance service delivery and continuity of care for this community.
Notes
Conflict of Interest
The authors have no conflicts of interest associated with the material presented in this paper.
Funding
This work is jointly funded by a Trust Waikato Community Impact Grant and Wintec – Te Pūkenga. The consumables used in health screenings are funded by Braemar Charitable Trust.
Acknowledgements
The authors would like to acknowledge Te Kotahi Oranga students and staff (Melissa Castillo – Registered Nurse; Mary Bowe – Occupational Therapist) involved in the pilot health screening programme, all participants, and Professor Patrea Andersen for her feedback on the manuscript.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Author Contributions
Conceptualization: Yap JR, Brownie S. Data curation: Yap JR. Formal analysis: Yap JR, Zhai WW. Funding acquisition: Brownie S. Methodology: Yap JR, Brownie S. Project administration: Yap JR, Zhai WW. Visualization: Yap JR. Writing – original draft: Yap JR, Brownie S, Zhai WW, Pak CS. Writing – review & editing: Yap JR, Brownie S.