An Exploratory Mixed Method Cross-Sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program.

BACKGROUND: Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations. OBJECTIVES: 1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students' responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success. DESIGN: This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai'i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community. PARTICIPANTS/SETTING: Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed. ANALYSIS: Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council. RESULTS: Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need. CONCLUSION: Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.

Pathway out of poverty: a values-based college-community partnership to improve long-term outcomes of underrepresented students.

BACKGROUND: Native Hawaiians, representing 25% of Hawai'i's population, suffer socioeconomic and health strains as evidenced by overrepresentation in low-wage jobs without health insurance and a higher prevalence of chronic disease compared with Hawai'i's other ethnic groups. Native Hawaiians are more likely to attend community colleges than 4-year colleges and have high dropout rates. OBJECTIVE: To describe a culturally relevant, community-based action research approach to build a program to keep Hawaiians in college to advance career options and improve long-term health and socioeconomic outcomes. METHODS: Culturally relevant approaches that depended on participation from a variety of community partners were used to evaluate needs and design interventions. RESULTS: The Pathway Out of Poverty Program uses Hawaiian values and traditions of healthy living to lead students through a nursing pathway from nurse aide (NA) to licensed practical nurse (LPN) to registered nurse (RN), with inherent increases in wage-earning potential. In the first 3.5 years, 150 students enrolled in NA training, and 135 students (90%) graduated and were certified. Of the 135, 77 (57%) transitioned to higher education and 79% transitioned to jobs that offered health insurance (20% were in both groups). Of the 77 entering higher education, 33 (43%) aimed for a degree in nursing. Students expressed growing interest in health promotion for themselves, family members, and others. CONCLUSION: Community partners were key to developing a successful community college-based Pathway Program to help marginalized and other underrepresented students move from low-wage to living-wage jobs and improve their long-term health outcomes.

Engaging nurse aide students to develop a survey to improve enrollment and retention in college.

BACKGROUND: Students from lower socioeconomic status (SES) backgrounds have historically experienced high rates of college dropout. Surveys often are used to assess supports and barriers (SB) to college enrollment and completion, and findings drive the design of interventions to improve student recruitment and retention. However, standard surveys may not include questions that solicit the breadth of issues facing low-income minority individuals. OBJECTIVES: We used community-based participatory research (CBPR) principles to develop an SB survey to better reflect the concerns of rural, first-generation college students in Hawai'i. METHODS: An advisory panel (AP) of students and community partners guided the work. The literature informed the first draft of the SB survey. Then we worked with students who had successfully completed a vocational Nurse Aide (NA) Training Program (NATP) course to refine four versions of the SB survey through multiple cycles of online survey review and focus groups. RESULTS: The final product included questions in new areas and differently phrased questions in standard areas (e.g., transportation, dependent care, housing, financial aid) to better capture reasons for students dropping out. The survey has proven useful as a student assessment tool, and findings are being used by instructors, counselors, and community partners to add resources and modify programs to increase student success in community college. CONCLUSIONS: Findings confirm the usefulness of engaging target partners in tool development. An enhanced understanding of SB of students from underrepresented groups will help to improve college recruitment and retention interventions.