A scoping review of health research in four Pacific Island countries and areas (Cook Islands, Fiji, Guam and Tonga) from 2014 to 2024.

Health research capacity remains constrained in Pacific Island Countries. This scoping review examined health research output in the Cook Islands, Fiji, Guam, and Tonga from 2014 to 2024 following the Arksey and O'Malley framework. A total of 752 publications met inclusion criteria, with output increasing markedly after 2020. A total of 447 studies (59%) were from Fiji, 142 (19%) from Guam, 95 (13%) from Tonga, and 68 (9%) from Cook Islands. Most studies described problems or causes, with fewer solution-focused, implementation, and evaluative studies. Majority of studies had international corresponding authors, and only half of studies included local co-authors. Where reported, two thirds had funding from primarily international sources, and local research ethics approval was present in less than half of the studies. These findings highlight concerns about research equity and sustainability, suggesting a need for greater local ownership, domestic funding, and ethical oversight to strengthen health research ecosystems in these countries.