Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants' diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai'i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoombased electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions;however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships' Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders.

A multilevel intervention increased accrual of Native Hawaiians and other Pacific Islanders to a national breast cancer screening trial

Background: The University of Hawaii Cancer Center (UHCC) Minority/Underserved NCI Community Oncology Research Program (Hawaii MU NCORP) provides access to NCI-sponsored clinical trials in Hawaii. The Hawaii MU NCORP is dedicated to increasing minority and underserved accruals to clinical trials. Native Hawaiian women have the highest breast cancer incidence and mortality;only 26% of Micronesian women in Hawaii over the age of 40 have ever had a mammogram. In 2018, the Hawaii MU NCORP became a recruitment site for the ECOG-ACRIN Tomosynthesis Mammographic Imaging Screening Trial (TMIST). A pilot study was launched in 2019, to support our NCORP recruitment of underrepresented Native Hawaiian and other Pacific Islander (NHPI) women to the TMIST study. Subsequently, specific funding was provided by the NCI's Center to Reduce Cancer Health Disparities that enabled the UHCC's Office of Community Outreach and Engagement (COE) to develop an effective multilevel recruitment strategy together with the Hawaii MIU NCORP. Methods: To foster community awareness of the TMIST study among NHPI women, the UHCC COE hired a Community Health Educator (CHE). The CHE, a Pacific Islander woman, utilized small group educational sessions to provide culturally and linguistically appropriate cancer prevention information and promote the TMIST study to NHPI women in Hawaii. The CHE worked in partnership with Hawaii MU NCORP clinical research associates (CRAs) in these efforts. In 2020, statewide COVID-19 health and safety protocols were enacted, limiting public group interactions in Hawaii. Despite this challenge, the CHE successfully adapted the in-person educational sessions on clinical trials and TMIST to conduct sessions using Zoom and Facebook Messenger. Results: Before the hire of the CHE in 2019, only one Pacific Islander (Micronesian) woman was recruited to the TMIST in Hawaii. The CHE conducted 21 community health events with 426 attendees from 2019 to 2021. The Hawaii MU NCORP NHPI TMIST enrollment went from the 9.9% in 2018 to 2019, to 20.1% in 2019 to 2020 and to 33% in 2020 to 2021. To date, 18 Micronesian, 52 Native Hawaiian and 6 Other Pacific Islander women out of 353 participants ware enrolled. Conclusions: The multilevel intervention of our CHE, in collaboration with NCORP staff providing clinical trial awareness training and community outreach, resulted in increasing the enrollment of NHPI women to the TMIST Trial. CHE-led community health education sessions on cancer prevention can be delivered using emergent technologies and social media. The use of culturally and gender concordant CHEs working with CRAs have the potential to increase awareness and accruals to cancer clinical trials.