A participatory research approach to address data needs in tobacco use among Native Hawaiians.

OBJECTIVES: This case study describes the first phase of collaboration among three entities: 1) Papa Ola Lokahi (POL) a community-based consortium that focuses on Native Hawaiian health concerns, 2) the Hawaii State Department of Health's Tobacco Prevention and Control Program (TPCP) and, 3) five community-based, Native Hawaiian Health Care Systems (NHHCS) that provide health promotion and screening services to Native Hawaiians statewide. METHODS: We utilized a participatory action research approach to address the need for ethnic-specific information on smoking attitudes and behaviors. Collaboratively, each party provided resources and/or skills, which produced outcomes relevant and meaningful to each. FINDINGS: This collaborative process resulted in 1) a user-friendly survey tool that gathered data of interest to all three groups; 2) a positive experience in data collection; 3) community-specific results with direct application to the NHHCS; 4) well-formatted reports that made them easy for each NHHCS to present the findings to their staff and participants; and 5) an expanded community capacity for future health promotion action. CONCLUSIONS: This modest achievement represents the first phase of a participatory research process that promotes and supports the needs and efforts of Native Hawaiian communities to actively identify, address and resolve their concerns about tobacco use.

Diet-related cancer in Native Hawaiians.

BACKGROUND: Since contact with Westerners in 1778, the native people of the Hawaiian Islands have experienced multiple health and social problems. Among these are the debilitating effects of high rates of cancer incidence and mortality. METHODS: The method used in this article was a review and integration of the literature on cancer among Native Hawaiians. The empiric and conceptual literature related to cancer among Native Hawaiians has emerged primarily in the past two decades; therefore, it is limited and sometimes not fully complete. Despite the restricted nature of the literature, there is sufficient evidence to indicate the disproportionate rates of cancer among this native population. RESULTS: An important result of this review is the prescription regarding the incorporation of cultural practices and beliefs into health care services. In particular, incorporating the traditional Hawaiian diet into nutrition programs aimed at health education and promotion may have long-term consequences for cancer prevention. Preliminary data on dietary intervention for Native Hawaiians reveal success on several health indices. CONCLUSIONS: Intervention programs that use elements of a culture, such as the traditional Hawaiian diet, reflect the inherent strengths of that culture. A resolution to improve health status of Native Hawaiians in the 21st century will, in part, require a respect and systematic inclusion of such traditional elements into health care services.

Participatory research in a Native Hawaiian community. The Wai'anae Cancer Research Project.

BACKGROUND: Community participation was a key component of a cancer control research project in a Native Hawaiian community. This project tested the effectiveness of a culturally appropriate intervention as a means of increasing breast and cervical cancer screening practices among Native Hawaiian women on the Wai'anae Coast of the island of O'ahu. METHODS: The Wai'anae Cancer Research project was community driven, with Native Hawaiian community representatives involved in all phases of the project, from grant proposal development to data interpretation. A community health center administered the grant award from the National Cancer Institute. The policymaking steering committee included community representatives, health professionals, and researchers to balance community and scientific quality standards. A factor in the project's success was continuous involvement over 7 years by a core of community representatives and professional staff. RESULTS: More than 500 women participated in the intervention, and outcome measures indicated that there was a community wide impact on cancer-related knowledge, attitudes, and behaviors. Important contributions of the project also included direct economic benefits, improvements in health services and systems, increased research capabilities, and dissemination of findings to other communities and researchers. CONCLUSION: Community participation in all phases of the research was essential in generating community acceptance and resulted in an innovative and effective intervention. This participatory research project has left the community richer in knowledge, skills, experience, confidence, and resources. These qualities provide a strong foundation for building future programs and research.

A breast and cervical cancer project in a native Hawaiian community: Wai'anae cancer research project.

BACKGROUND: This article describes a breast and cervical cancer control project in a Native Hawaiian community and presents preliminary findings from its first year. The project is community driven, with Native Hawaiian community investigators and advisors involved in all phases of the research project. Its purpose is to test the effectiveness of a culturally appropriate intervention as a means of increasing breast and cervical cancer screening practices among Native Hawaiian women. METHODS: This article discusses the process of community participation in the development of a baseline survey as well as selected findings from that survey. A baseline telephone survey was conducted to obtain an initial assessment of community knowledge, attitudes, and behavior related to cancer. Community representatives were an integral part of the research team that planned and implemented the survey. RESULTS: A total of 1,260 women drawn equally from the study and the control communities participated in the survey. A majority of those surveyed in both communities indicated adherence to cancer screening recommendations. Seventy-three percent of the women reported having obtained a Pap test during the past 2 years. Fifty-nine percent of women over 40 years of age reported having had a mammogram during the past 2 years. Twenty-eight percent reported having used Hawaiian remedies within the past year. Thirty-six percent of the women reported encouraging others to obtain cancer screening services. DISCUSSION: Though a majority of the target population are following cancer screening guidelines, a significant minority are not. While the project intervention aims to change the screening behavior of women not currently getting cancer screening, it plans to do so by enlisting the women already in compliance to reach others in their social networks who are currently not getting cancer screening. The involvement of community representatives, working alongside researchers, in baseline survey planning helped assure the survey was acceptable to the participants and the community as a whole. This process is illustrative of a participatory research commitment which underlies success in the early phase of this Native Hawaiian research project.

High mortality rates in Native Hawaiians.

Native Hawaiians continue to have higher mortality rates than do other ethnic groups in Hawaii. This discrepancy becomes even more pronounced when rates are calculated separately for full-Hawaiians versus part-Hawaiians versus all races. In an exploratory discussion of these data, a group of Native Hawaiian physicians recommend greater attention be given to Native Hawaiian values and participation in health care delivery, increasing access to services, and further research.