Over the last few decades, the backbone of monitoring child health has been the use of growth chart and childcare records (King, M. 1978). These have been more widely used in developing countries than in developed countries because of lower accessibility of health services. Since the universal promotion of Primary Health Care in 1978 (WHO/UNICEF, 1978), there has been an increase in the investment on child health monitoring, albeit insufficient, especially in deprived communities of both developing and developed countries.
In New Zealand, monitoring of child health have been systematically developed through Plunket and Public Health nursing services (MOH, 1998). The focus has been the use of Well Child Health book (WCH). Over the years, the WCH book have developed from growth monitoring using weight, height and age to a comprehensive booklet to cover growth monitoring, immunization, nutritional status, records of sickness episodes and other reasons for use of health services. The latter version has also included health promotion materials for mothers and health care workers.
The wide use of the WCH book has not been accompanied by stringent research to assess its efficacy. That is, the book has been widely used but to date no research have demonstrated that the health of children using the book is better than those not using the book. Much of the work done has been focussed on the utilization and coverage.
This project is a pilot study qualitatively assessing the use of the WCH book among Tongan mothers. There is no ethnic specific data available to examine ethnic specific aspects of use of the WCH book among communities wherein English is a second language. This study will also contextualise the knowledge, attitude and practice of the WCH book of Tongans in Auckland.



The research objectives were:

' To explore Tongan mothers attitudes towards the Well Child Health book and it's usefulness

' To develop recommendations for better utilization of the Well Child Health book by Tongan mothers.

What is Well Child Health book?

It is an information book about health and development of child. This book is for the mother to keep and use for your child. It is part of the Well Child - Tamariki Ora Program. The program helps parents and caregivers keep children well by providing:

' Support
' Information and advice and
' Regular health checks as your baby grows.

All children develop at different rates. Your child will have her own state of wellness and health.

The Well Child-Tamariki Ora checks is done by a nurse, doctor or midwife who has been specially trained to do immunization and child screening checks of babies and children.

The Well Child-Tamariki Ora health workers include midwives, nurses, doctors, community health workers, dental therapists and vision-hearing testers. These health workers are all there to help you bring up a healthy happy child.




METHODS

Five Tongan mothers in the Auckland area were selected to take part in this research. Convenience sampling method was used, as they were easy to be recruited, likely to participate and respond and near at hand (Bowling, A. 1997). Moreover, there is no language problem. These mothers were recruited during a Pacific consultation for maternity review in Auckland. Having identified their names, they were then approached about the research, which they were all happy to participate. Names, phone numbers and addresses were taken so I could contact them for the interviews. The youngest respondent was 21 and the oldest was 38 years old. Of the five mothers, one was a single mother and the rest were all married. Geographically, one respondent was from Pakuranga; one from Otahuhu and the other three respondents lived in Mangere.

Contact was made and time was arranged for the interview. Each prospective participant was met and explained about the research at their own place. An information sheet (information sheet enclosed) outlining the research project and what is involved was given to these respondents. Two of the respondents needed the information sheet and consent forms explained and translated into Tongan.

Once consent had been obtained, a face to face interview was undertaken. The interview were semi structured (Robson, C. 1993). The interview began with an introductory talk in which thanks was extended to them for their participation, explaining the project briefly, explaining the consent form and confidential issues, explaining her right to ask questions, withdraw herself or any information from the study (Robson, C. 1993). When all the above issues were dealt with, the respondent was asked to sign the consent from (consent from attached). Questions asked were related to these areas:
' Understanding of WCH book
' Usage and usefulness of the WCH book
' Duration of use and why stopped
' Recommendations
An open-ended question for each area was prepared in order to get a checklist for the interview (Robson, C. 1993). Probing questions to clarify answers and to cover the area followed each main question (Bowling, A. 1997). Each interview lasted around 30 - 45 minutes and took place at the participants; home. All interviews were undertaken in the participant's first language (Tongan) and audiotaped with the consent of the participant. There was no objection at any point in time about being audiotaped. Relevant facts were also noted during the interview, which would help clarify specific issues.

Audiotaped interviews and notes were transcribed into English. During the analysis stage, the information from the transcription was first categorized according to the main areas (David, R.T. 1996). Then the frequency of each datum was counted in order to get quantitative data set of the research. Data, which go together, are grouped so as to develop sub-categories under the main categories. Repeated scrutinizing the quantitative data set (David, R.T. 1997), the recorded tape and the transcription helped to do a qualitative data analysis, which is described in the research finding section.

RESEARCH FINDINGS

Research findings are presented under these main headings:

1. Understanding of WCH book
2. Understanding of usage of the book
3. Usefulness of WCH book
4. Duration of usage of book
5. Barriers to using the book
6. Recommendations





1. Understanding of WCH book
According to the research findings, 3 of the 5 participants had a very good understanding of the book. One had a fair idea of what the book was about and one participant had no idea of what the book was used for except for immunization records. The five participants had different level of understandings, which depended a lot on who and how the information was explained to them.

1.1 Where the WCH book was given
Four of the participants said that the book was given to them at the hospital before they left the hospital. One of the participants got given the book at home when the nurse visited the next day after being discharged. The respondent said:

I saw the nurse giving the book to one of the mothers. When I left I wasn't given a book and I was worried and concerned that something might happen to baby and I wouldn't know what to do especially when this is my first baby.

1.2 Who gave the book?
All the five participants mentioned that a nurse gave them the book. One responded:
I was not sure what sort of nurse gave me the book because they all looked the same and they were all nurses to me.

Another respondent said:
There were so many nurses there, I was not sure whether they were ma'uli (midwife), doctor or just a Pink nurse (trainee nurse in Tonga), you know what I mean eh! All I know I got given a book by a nurse.

1.3 Explanation of the book
All five participants mentioned that there was minimal explanation about the book by the nurse. The degree of explanation ranged from here's the book, go and read it to assuming that we all know about the book. Three of the participants spoke fluent English, and the other two had very little understanding of the English language. One respondent said:
The nurse came and gave me the book and ...