The Dean's Certificate of Distinction in Native Hawaiian Health.

Certificates of Distinction at USA medical schools are given to students who have shown additional commitment and effort in areas such as global health and social justice. In 2014, the Dean's Certificate of Distinction in Native Hawaiian Health (COD-NHH), at the John A. Burns School of Medicine (JABSOM), was designed to offer more experience and knowledge in Native Hawaiian health, as well as directly benefiting Native Hawaiian communities through personal and cultural growth, service learning and scholarly projects. The COD-NHH utilises the Department of Native Hawaiian Health 'na pou kihi' framework represented by a hale (house). This framework embodies the Native Hawaiian holistic view of health and incorporates traditional values and cultural strengths, critical to ensure that students can work comfortably and effectively in our communities. Activities focus on four 'pou kihi' (pillars): (1) cultural knowledge and space; (2) community/environmental stewardship; (3) knowledge advancement and dissemination; and (4) social justice. The first cohort received their COD-NHH in May 2017. Interest among JABSOM students is expanding. The COD-NHH, though well received, has required some modification including new technology for data collection of requirements. Feedback from the community is positive and continued community partnerships allow for opportunities of engagement with the student.

Professional and Cultural Development of Medical Students Mentoring Adolescents in a Predominately Native Hawaiian Community.

First year medical students (MS1s) increase their skills in medical professionalism and their understanding of adolescent needs and cultural humility through an intermediate and high school health career pathway/mentoring program. Teaching and service-learning activities incorporate health promotion and traditional Native Hawaiian practices and provide experiences that help MS1s to understand concepts important to medical professional development and adolescent mentoring. The content of this article was presented as a workforce development session at the 2018 Pacific Region Indigenous Doctors Conference. Methods: This article describes the program curriculum for MS1 community health electives mentoring rural, underserved, predominantly Native Hawaiian students and examines the training elements and reflections from 40 MS1s participants in the first four years of the Nanakuli Pathways to Health teen mentoring program. Student reflections were themed and analyzed for content discussing the students' professional development and experience in mentoring. Results: Analysis of four separate medical student cohorts enrolled in a teen mentoring community health elective demonstrate that mentoring relationships and program curricula helped them to develop skills in medical professionalism including establishing relationships, self-reflection, self-evaluation, communication, compassion, excellence in teaching, and a deepened understanding of native Hawaiian culture and health disparity.

Addressing health disparities by building organizational capacity in the community: a case study of the Wai'anae Coast Comprehensive Health Center.

Native Hawaiians and other residents living in economically disadvantaged communities suffer disproportionately from many health conditions, especially chronic diseases. Reversing this trend requires a comprehensive approach encompassing more than just improvement in healthcare delivery. Indeed, societal changes at multiple levels must occur, including environmental, systems, and policy change, in order to bring about sustainable improvements in community health and wellness. A key strategy to accomplish these upstream changes is an increase in the capacity of community-based organizations to provide leadership in health advocacy, support community health promotion, prioritize resource allocation, and participate in community health research. In disadvantaged communities where health disparities are the most severe, community health centers (CHC) are well positioned to take a pivotal role in these efforts. This report is a case study to describe processes taking place at Hawai'i's largest CHC to build organizational capacity and bring about upstream changes that improve community health and wellness. Ongoing processes at the CHC include (1) Institutional: commitment to address health disparities, expand the CHC research infrastructure, and develop a comprehensive worksite wellness program (2) Collaborative: development of a network of community partners committed to the common goal of improving the health and wellness of community residents, and (3) Systems and Policy: activities to strengthen the CHC's and community's ability to influence systems changes and policies that reduce health disparities. Preliminary results are encouraging although the processes and timelines involved require a long-term commitment in order to affect tangible results that can be measured.

A community-based asthma management program: effects on resource utilization and quality of life.

OBJECTIVE: The Waianae Coast Comprehensive Health Center (WCCHC) developed an integrated community-based asthma management program in an effort to reduce inappropriate medical utilization and improve quality of life in their pediatric asthma population. METHODS: Over a period of three years, eighty-eight children with asthma participated in the community-based asthma management program. During this time, an automated asthma tracking system was developed, the WCCHC established a standard system of care based on the National Asthma Education and Prevention Program Expert Panel Report Guidelines for the Diagnosis and Management of Asthma (NAEPP Asthma Guidelines) adapted for cultural sensitivity, and a coordinated team care approach was implemented in the asthma management program. RESULTS: During the pilot study, forty children participated in the program. Among these forty individuals, there was a significant decrease in both per capita expenditures and asthma related visits after community health worker (CHW) intervention. Average per capita charges decreased from dollar 735 to dollar 181, Emergency Department (ED) visits decreased from 60 to 10, and the overall asthma related visits decreased from 1.5 to 0.25 per person after the initial CHW encounter. These results were replicated during the 2000-2001 intervention period where average per capita charges decreased from dollar 310 to dollar 129 and ED encounters dropped from 32 to 10 after the first CHW encounter. In addition, the number of high utilizers-defined as those presenting to the ED two or more times for asthma-related diagnoses- sharply decreased from 176 in 1998 to only 16 in 2001. Quality of life improved, with 72% fewer nighttime and 96% fewer daytime symptoms reported after CHW intervention during the pilot study. During the year 2000, symptoms during exercise and asthma related doctor visits decreased 59% and 67% respectively after CHW intervention. CONCLUSION: The community-based asthma management program demonstrated success in improving utilization patterns and reducing asthma-related expense among program participants. Improvement was also noted in quality of life as expressed through frequency and time of asthma symptoms. Other health care institutions may also be positively impacted by developing multidisciplinary team implemented, culturally-adapted, and scientifically-based disease management programs.