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Aim: Ear and hearing health services are scarce within Pacific Island countries. Where available, they remain under-resourced, despite there being a high estimated prevalence of otitis media and otitis media-related hearing loss. This study examines the potential for improving ear and hearing health strategies by examining key factors, opportunities and challenges, working with Fiji as a case study., Method: A series of semi-structured interviews were conducted with professionals who had experience in otitis media programme implementation and/or professionals with working experience within the Pacific region and the Fiji health system. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis methods., Results: The three main themes, Identification, Integration, Sustain, highlight the importance of a Pacific-based, locally-driven strategy that builds on existing infrastructure. Three operational themes, Advocacy, Funding and Long-Term Vision, were pivotal to the viability of the main themes., Conclusion: Despite significant challenges, there is potential to develop sustainable otitis media identification, treatment and prevention strategies in Fiji. The sustainability of such a strategy is contingent on a number of key factors, which includes a long-term commitment by stakeholders, be culturally appropriate and responsive to local need, develop close linkages across health, social and educational sectors, and ensure it is embedded within a broader public health framework., Competing Interests: Ms Holt reports grants from The University of Auckland during the conduct of the study.

Problem/context: The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS). Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change., Action: To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders., Outcome: Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies., Discussion: Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.