Health Disparities Investigator Development through a Team-Science Pilot Projects Program.

Profound health disparities are widespread among Native Hawaiians, other Pacific Islanders, and Filipinos in Hawai'i. Efforts to reduce and eliminate health disparities are limited by a shortage of investigators trained in addressing the genetic, socio economic, and environmental factors that contribute to disparities. In this conference proceedings report from the 2022 RCMI Consortium National Conference, we describe our mentoring program, with an emphasis on community-engaged research. Elements include our encouragement of a team-science, customized Pilot Projects Program (PPP), a Mentoring Bootcamp, and a mentoring support network. During 2017-2022, we received 102 PPP preproposals. Of these, 45 (48%) were invited to submit full proposals, and 22 (19%) were awarded (8 basic biomedical, 7 clinical, 7 behavioral). Eighty-three percent of awards were made to early-career faculty (31% ethnic minority, 72% women). These 22 awards generated 77 related publications; 84 new grants were submitted, of which 31 were awarded with a resultant return on investment of 5.9. From 5 to 11 investigators were supported by PPP awards each year. A robust usage of core services was observed. Our descriptive report (as part of a scientific conference session on RCMI specialized centers) focuses on a mentoring vehicle and shows how it can support early-stage investigators in pursuing careers in health disparities research.

Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach.

Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kupuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kupuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kupuna health and service use.

The Research Centers in Minority Institutions (RCMI) Translational Research Network: Building and Sustaining Capacity for Multi-Site Basic Biomedical, Clinical and Behavioral Research.

The Research Centers in Minority Institutions (RCMI) program was established by the US Congress to support the development of biomedical research infrastructure at minority-serving institutions granting doctoral degrees in the health professions or in a health-related science. RCMI institutions also conduct research on diseases that disproportionately affect racial and ethnic minorities (ie, African Americans/Blacks, American Indians and Alaska Natives, Hispanics, Native Hawaiians and Other Pacific Islanders), those of low socioeconomic status, and rural persons. Quantitative metrics, including the numbers of doctoral science degrees granted to underrepresented students, NIH peer-reviewed research funding, peer-reviewed publications, and numbers of racial and ethnic minorities participating in sponsored research, demonstrate that RCMI grantee institutions have made substantial progress toward the intent of the Congressional legislation, as well as the NIH/NIMHD-linked goals of addressing workforce diversity and health disparities. Despite this progress, nationally, many challenges remain, including persistent disparities in research and career development awards to minority investigators. The continuing underrepresentation of minority investigators in NIH-sponsored research across multiple disease areas is of concern, in the face of unrelenting national health inequities. With the collaborative network support by the RCMI Translational Research Network (RTRN), the RCMI community is uniquely positioned to address these challenges through its community engagement and strategic partnerships with non-RCMI institutions. Funding agencies can play an important role by incentivizing such collaborations, and incorporating metrics for research funding that address underrepresented populations, workforce diversity and health equity.

Insights in Public Health: Ke A'o Mau: Strengthening Cultural Competency in Interdisciplinary Education.

In order to successfully address social determinants of health and to achieve social justice for kanaka and all the people of Hawai'i, we must broaden our understanding of and approach to healing/health through interdisciplinary, culturally-informed education. Strengthening cultural competence within an Interprofessional Education framework, has potential in meeting important challenges in patient and population health, including meeting the increased demand for culturally trained professionals, increasing access to providers, and reducing health inequities in kanaka (Native Hawaiians). We present a model of course design and delivery, Ke A'o Mau (Learning Preserved), intended to provide haumana (students) with a unique body of culturally-anchored and community-based knowledge, skills and values that facilitate work with kanaka. Ke A'o Mau was implemented in the 2017-2018 academic year at University of Hawai'i (UH) at Manoa and optimized the authenticity of cultural learning through the engagement of kumu loea (expert teachers) to instruct in their area of expertise. Design and delivery of the course began with the understanding and honoring of kanaka worldviews, knowledge, and practices. Appraisal of haumana learning showed strong evaluative scores, of knowledge development, skills training, and instructional materials. This course not only seeks to resolve critical challenges in patient and population health but also provides a model to support the UH Manoa strategic priority of "striving to be a foremost indigenous-serving institution."

Leading by Success: Impact of a Clinical and Translational Research Infrastructure Program to Address Health Inequities.

Building research infrastructure capacity to address clinical and translational gaps has been a focus of funding agencies and foundations. Clinical and Translational Sciences Awards, Research Centers in Minority Institutions Infrastructure for Clinical and Translational Research (RCTR), and the Institutional Development Award Infrastructure for Clinical and Translational Research funded by the US government to fund clinical translational research programs have existed for over a decade to address racial and ethnic health disparities across the USA. While the impact on the nation's health cannot be made in a short period, assessment of a program's impact could be a litmus test to gauge its effectiveness at the institution and communities. We report the success of a Pilot Project Program in the University of Hawaii RCTR Award in advancing careers of emerging investigators and community collaborators. Our findings demonstrated that the investment has a far-reaching impact on engagement with community-based research collaborators, career advancement of health disparity investigators, and favorable impacts on health policy.

Native Hawaiian and Pacific Islander Elders: What Gerontologists Should Know.

Native Hawaiian and other Pacific Islanders (NHOPI) experience significant health disparities compared with other racial groups in the United States. Lower life expectancy has resulted in small proportions of elders in the population distribution of NHOPI, yet the number of NHOPI elders is growing. This article presents data on NHOPI elders and discusses possible reasons for continuing health disparities, including historical trauma, discrimination, changing lifestyle, and cultural values. We outline promising interventions with NHOPI and make suggestions for future research.

Listening to the voices of native Hawaiian elders and 'ohana caregivers: discussions on aging, health, and care preferences.

Native Hawaiians, the indigenous people of Hawai'i, are affected by varying social and health disparities that result in high prevalence of chronic disease, early onset of disability, and shorter life expectancy compared to other ethnic groups in Hawai'i. Six listening meetings were conducted, involving 41 community-dwelling kupuna (Native Hawaiian elders) and 'ohana (family) caregivers to investigate health and care preferences that offer the potential for improving well-being in later life for Native Hawaiian elders. As background, we provide three explanatory perspectives and theories­life course perspective, minority stress theory, and historical trauma­that guided the design of this study and provided the study's context. A number of overarching themes and subthemes were identified, some of which point to universal concerns with age and caregiving (such as challenges and costs associated with growing old and caregiving) and others that are culturally specific (such as influence of culture and social stressors, including discrimination, on health needs and care preferences). Results give further support to the urgency of affordable, accessible, and acceptable programs and policies that can respond to the growing health and care needs of native elders and family caregivers.

Adversity and resiliency in the lives of Native Hawaiian elders.

Native Hawaiians constitute 401,000 or 0.1 percent of the total U.S. population, with approximately 60 percent residing in the state of Hawai'i. In Hawai'i, Native Hawaiian elders (na kapuna) face a number of social and health disparities when compared with their non-Native Hawaiian counterparts: higher rates of poverty, greater disability rates, higher rates of specific life-threatening diseases, shorter life expectancies, and lower utilization rates of some services. Integrating life course literature and resiliency theory, the authors propose a model that provides a context from which to analyze and understand social and health disparities found among older Native Hawaiians. The authors introduce a historical timeline that identifies key cultural and historical markers in the lives of na kapuna and then link this timeline to health and social-health delivery strategies. This model offers a rationale for the development and implementation of culturally based solutions for na kapuna and underscores the need for social workers to intervene at the micro, meso, and macro levels to affect the well-being for this and other ethnic populations.

Using a community-based participatory approach to create a resource center for Native Hawaiian elders.

CONTEXT: Historically, Native Hawaiian elders have been recognized as the major sources of wisdom and transmitters of knowledge and training to younger generations. Yet, concerns exist today for these elders who experience shorter life expectancies, poorer health and greater disability than elders in other ethnic groups in Hawai;i. OBJECTIVE: We describe Ha Kupuna: National Resource Center for Native Hawaiian Elders, established at the University of Hawaii to address disparate health and improve the access and delivery of services to these elders. METHOD: Ha Kupuna is described in accordance with the principles of community-based participatory (CBP) research with its unique emphasis on culturally competent practice. RESULTS: Application of the CBP approach is illustrated in the following steps: community engagement; development of an infrastructure; implementation and dissemination of research and technical assistance projects; and evaluation. DISCUSSION: The CBP approach is highly relevant for Native Hawaiians because of its alignment with cultural values, the mobilization of the community and the emphasis on reducing health inequities through social change. In adhering to a CBP approach to improve the health of elders, Ha Kupuna seeks to perpetuate the culture through the transmission of ha (breath) from older to younger generations.