Utilizing Filipino key informants to guide community outreach for cancer prevention in Hawai'i.

OBJECTIVE/DESIGN: The University of Hawai'i Cancer Center works with academic and community partners to examine health disparities and inequities that persist among Pacific Island Populations through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Partnership's Community Outreach Core (COC) assists and promotes cancer research and helps to ensure the integration of historically excluded community perspectives by utilizing community-engaged and culturally-grounded approaches to reduce cancer burdens. However, cancer health disparities among Filipinos demonstrate a need for cancer-control initiatives within this community. SAMPLE/MEASUREMENTS: COC staff conducted five semi-structured key informant interviews with Filipino nurse and healthcare leaders in Hawai'i to establishpartnerships with the community, as well as provide community-driven guidance for future cancer prevention and control efforts. RESULTS: The informants provided recommendations for COC community engagement, relationship building, and future areas of directed cancer focus. The interviews also initiated relationship-building and community collaborations for directed cancer education and resources within Filipino communities. CONCLUSION: The themes uncovered from the interviews provided guidance on how to begin addressing cancer concerns, and led to the informants' subsequent membership in our Outreach Advisory Council to engage in future collaboration with the Filipino community and a framework for future community-engaged cancer prevention efforts.

Island Nation, US Territory and Contested Space: Territorial Status As a Social Determinant of Indigenous Health in Guam.

The United Nations and International Federation of Social Work affirm the right of all people to determine their political status, preserve their environments and pursue endeavours for well-being. This article focuses on CHamoru, Guam's Indigenous people, and examines distal social determinants of health (SDOH) in the contested spaces of US territorial status and non-self-determining Indigenous nationhood. Published multi-disciplinary literature identified ways in which territorial status functions as an SDOH unique to non-self-determining Pacific Island nations. Indicated is the use of structural approaches that address mechanisms of US power and control, including economic policies that 'defacto' promote coca-colonisation and non-communicable diseases risk. Critical race theory centres race, colonisation and subversive narratives. In line with fourth-generation SDOH action-oriented research, we posit a CHamoru critical race theory model that weaves Indigenous, social work and public health perspectives. Lack of community input is a limitation of the current research. To assure relevance, the model will be vetted through community discussions. Our discussion guide may be tailored for other Indigenous communities. Social workers may play a meaningful role in promoting health equity through participatory action-oriented, cultural-political social work that upholds Indigenous self-determination and survivance in contested spaces.

Is healthcare caring in Hawai'i? Preliminary results from a health assessment of lesbian, gay, bisexual, transgender, questioning, and intersex people in four counties.

This paper presents findings from a statewide needs assessment of lesbian, gay, bisexual, transgender, questioning, and intersex (LGBTQI) people in Hawai'i that relate to health status and health-related risk factors such as having health insurance coverage, having a regular doctor, experiencing sexual orientation (SO) or gender identity/expression (GI/E) discrimination in health/mental health care settings, and delaying care due to concerns about SO and GIE discrimination in Hawai'i, Honolulu, Kaua'i, and Maui counties. Results suggest that LGBTQI people in these counties generally rated their self-assessed health as "very good" or "excellent," but had slightly higher rates of smoking and less health insurance coverage than the general population of Hawai'i. Many respondents reported challenges to their health, and negative experiences with healthcare. Unlike prior studies that have shown no difference or a rural disadvantage in care, compared to urban locations, Hawai'i's counties did not have a clear rural disadvantage. Honolulu and Kaua'i Counties demonstrated better health indicators and lower percentages of people who had delayed care due to gender identity concerns. Findings suggest that health/mental health care providers should address potential bias in the workplace to be able to provide more culturally competent practice to LGBTQI people in Hawai'i.

Colorectal Cancer Screening at the Nexus of HIV, Minority Statuses, and Cultural Safety.

BACKGROUND: The incidence of non-AIDS-defining cancers has increased significantly among persons living with HIV (PLHIV). Screening education is recommended. PURPOSE: Social learning, minority stress, and cultural safety theories informed this pilot to assess the feasibility of a colorectal cancer screening intervention targeted to PLHIV, with additional tailoring for relevance to Native Hawaiians, a group with low participation in cancer screening. METHOD: The targeted education included behavioral modeling and barriers counseling in a culturally safe environment. Using a 2-group, pre/posttest design, AIDS service organizations were randomized to culturally responsive or standard education. AIDS service organizations consumers recruited through venue-based promotions were the unit of analysis. Knowledge-attitudes-practices, fecal occult blood test screening completion, and intervention feasibility were measured. RESULTS: Treatment arm participants, regardless of ethnicity, adhered to fecal occult blood test instructions and achieved increases in screening knowledge, attitudes, and practices. Relevance and acceptability of the educational intervention were endorsed. DISCUSSION: The culturally responsive intervention was successful in this group of PLHIV. Additional tailoring may be needed to reach PLHIV who do not participate in organizational activities. CONCLUSION/TRANSLATION TO HEALTH EDUCATION PRACTICE: This culturally responsive intervention shows promise for efficacy testing in a broader PLHIV population. Constituent-involving strategies were central to its development and delivery.