The Critical Role Hawai'i's Community Health Workers Are Playing in COVID-19 Response Efforts.

Community health workers play an instrumental role in the health care system and are critical partners in pandemic response. In Hawai'i, community health workers are working to reduce the burden of chronic disease among Pacific Islander, Filipino, and Native Hawaiian populations in partnership with government agencies and health care organizations. This commentary reviews the role community health workers in Hawai'i are playing in assisting with the COVID-19 response. Utilizing their skills and the community's trust, they are optimally positioned to reach marginalized and vulnerable populations hit hardest by COVID-19; community health workers educate, screen, and provide social service referrals to community members.

Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation.

Significant racial disparities in cancer mortality are seen between Medicare beneficiaries. A randomized controlled trial tested the use of lay navigators (care managers) to increase cancer screening of Asian and Pacific Islander Medicare beneficiaries. The study setting was Moloka'i General Hospital on the island of Moloka'i, Hawai'i, which was one of six sites participating in the Cancer Prevention and Treatment Demonstration sponsored by the Centers for Medicare and Medicaid Services. Between 2006 and 2009, 488 Medicare beneficiaries (45% Hawaiian, 35% Filipino, 11% Japanese, 8% other) were randomized to have a navigator help them access cancer screening services (experimental condition, n = 242) or cancer education (control condition, n = 246). Self-reported data on screening participation were collected at baseline and exit from the study, and differences were tested using chi-square. Groups were similar in demographic characteristics and baseline screening prevalence of breast, cervical, prostate, and colorectal cancers. At study exit, 57.0% of women in the experimental arm and 36.4% of controls had had a Papanicolaou test in the past 24 months (P = .001), 61.7% of women in the experimental arm and 42.4% of controls had had a mammogram in the past 12 months (P = .003), 54.4% of men in the experimental arm and 36.0% of controls had had a prostate-specific antigen test in the past 12 months (P = .008), and 43.0% of both sexes in the experimental arm and 27.2% of controls had had a flexible sigmoidoscopy or colonoscopy in the past 5 years (P < .001). Findings suggest that navigation services can increase cancer screening in Medicare beneficiaries in groups with significant disparities.

Similarity and differentiation between bacteria associated with skin of salamanders (Plethodon jordani) and free-living assemblages.

All animals and plants have intimate associations with microbes. Opinion has shifted from viewing microbes primarily as pathogens to the idea that healthy animals and plants carry specialized communities of coevolving microorganisms. However, the generality of this proposition is unknown because surveys rarely compare host-associated microbes with samples from relevant microhabitats. Symbiotic communities might be assembled from local environments with little evolutionary specialization. We evaluated the specificity of bacteria associated with salamander skin in comparison with surfaces in their immediate environments using 16S rRNA sequences. Host-associated and free-living samples were significantly different. However, relative abundances were strongly correlated; the most abundant taxa on salamander skin were also most abundant on moist debris on the forest floor. Thus, although bacterial assemblages on salamander skin are statistically differentiated from those on inanimate surfaces, they are not entirely 'distinct'. Candidate salamander specialists were few in number and occurred at low relative abundances. Within some OTUs, differences in allele frequency suggested genetic specialization at finer levels. Although host-associated and free-living assemblages were similar, a range of more or less specialized symbiotes was evident and bacteria on salamander skin were often specific genotypes of OTUs commonly found on other moist surfaces in the environment.

Helping cancer patients across the care continuum: the navigation program at the Queen's Medical Center.

Research suggests that cancer patient navigation improves care, but few reports describe the variety of patients managed by a hospital-based navigation program. Differences in navigated patients by the intensity (low, medium, or high) of navigation services they received were examined. The 835 clients seen by the navigators in a hospital-based cancer center were first stratified by quarter and by four ethnic groups. Randomized selection from each group assured there would be equal representation for analysis of Hawaiians, Filipinos, Japanese, and Whites and even numbers over all time intervals. Five professionals extracted data from these case records on demographics, type/stage of cancer, diagnosis and treatment dates, barriers, and navigator actions. Clients had breast (30.0%), lung (15.8%), esophageal (6.7%), colon (5.8%), ovarian (4.2%), prostate (3.3%), and other cancers (34.2%). The median number of actions taken on behalf of a client was 4 (range 1-83), and the median number of days a case was open was 14 (range 1-216). High intensity cases (those receiving more assistance over longer periods of time) were more likely than low-intensity cases to need help with education and reassurance, transportation, care coordination, and covering costs. Although there were no demographic differences across intensity groups, Neighbor Island patients from Hawai'i, Maui, Moloka'i, Lana'i and Kaua'i were more likely to need help with arranging travel, care coordination, and costs associated with getting treatment (all at P=.05), and patients on public insurance were more likely to have stage 4 cancer (P=.001) and to need help with costs (P=.006). Findings suggest that this hospital-based navigation program is filling a real need of patients across the cancer care continuum. A triage protocol and an integrated data capture system could help improve the targeting and documentation of cancer patient navigation services.

Cancer patient navigation case studies in Hawai'i: the complimentary role of clinical and community navigators.

This article describes the activities performed by cancer patient navigators in community-based and hospital settings. The case study demonstrates the depth and breadth of navigation activities and illustrates how hospital-based and community-based navigators work together to help individuals access cancer care and complete cancer treatment.

Using community-based research methods to design cancer patient navigation training.

BACKGROUND: Cancer mortality continues to be higher in Native Hawaiians than whites, and research has identified numerous barriers to good cancer care. Cancer navigator programs provide individualized assistance to patients and family members to overcome barriers, promoting early diagnosis and timely and complete treatment. OBJECTIVES: Our purpose was to design a training curriculum to provide community-based outreach workers serving Native Hawaiians with cancer patient navigator skills. METHODS: The Ho'okele i ke Ola (Navigating to Health) curriculum was informed by data gathered from Native Hawaiian cancer patients and their family members, outreach workers in Native Hawaiian communities, and cancer care providers. Based on findings, the 48-hour curriculum focused on cancer knowledge, cancer resources, and cancer communications. Three versions were developed: (1) six days of training and on-site tours in urban Honolulu; (2) four days of training on a neighbor island, with 2 days of on-site tours in Honolulu; and (3) a 3-credit community college independent study course. Graduates were interviewed after each session and 3 months after graduation about application of navigation skills. RESULTS: In 18 months, 62 health workers from community-based, clinical, and community college settings were trained -31 in Honolulu-based trainings, 29 in neighbor island trainings where earlier graduates served as co-faculty, and 2 through Maui Community College (MCC). Follow-up data suggest increased knowledge, skills, capacity, and feelings of competence among trainees. CONCLUSIONS: All three versions of the Ho'okele i ke Ola curriculum, developed with community input, have proven successful in increasing cancer patient navigation skills of trainees.