Predictors of indigenous healer use among Samoans

To determine the utilization of alternative modalities of care (i.e., indigenous healers or fofo) by Samoans, the indigenous peoples of the US Territory of American Samoa and examine predictors (i.e., socio-demographic, access to care, health status, culture-specific beliefs about disease etiology and treatment, and intentions to use healers) of utilization of fofo.

A cross-sectional design, with systematic, random sampling procedures.

1,834 adult Samoan men and women residing in American Samoa, Hawaii, and Los Angeles.

Prevalence and predictors of utilization of fofo. Multivariate logistic regression was performed to determine independent predictors of utilization of fofo.

The prevalence of use of fofo across the three study sites was 41.0%. The following variables emerged as significant predictors of use of fofo: older age (odds ratio [OR] = 1.60; 95% confidence interval [CI] = 1.25-2.06), resident of American Samoa (OR = 1.69, CI = 1.29-2.21), belief that indigenous healers can treat cancer (OR = 1.79, CI = 1.40-2.30), belief that some illnesses afflict only Samoans (OR = 2.15, CI = 1.72-2.70), and greater intentions to use a fofo (OR = 2.27, CI = 1.81-2.85). Some of the more common medical conditions for which Samoans used fofo were biomedically defined musculoskeletal and neurologic problems, and Samoan sicknesses (ma'i Samoa).

Population-based estimates of use of alternative modalities of care by Samoans are comparable to that reported for the general US population. However, the predictors of utilization of indigenous healers are more likely to be culture-specific health beliefs about disease etiology and treatment. There is a need to better understand Samoan traditional medicine and help-seeking behavior and explore whether indigenous Samoan healers can assist in the delivery of clinically proven and culturally sensitive health interventions to positively impact both disease management and preventative behaviour in this minority Polynesian population.