Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health最新文献

Community-based participatory research (CBPR) continues to be recognized as an effective research approach in which academic researchers work in partnership with communities to address health disparities. Although the literature suggests benefits associated with CBPR, more needs to be done to advance CBPR to ultimately reduce health disparities. Hawai'i presents a research-rich opportunity for CBPR because of its ethnic diversity and geographic location, resulting in close-knit communities with unique experiences and concerns. This study aims to better understand the experiences of academic researchers who are conducting CBPR in Hawai'i and their perceptions of its benefits and challenges as well as recommendations to advance the field. Twelve academic researchers with Hawai'i-based CBPR experience were interviewed. Four major themes emerged from their responses: the importance of prioritizing relationship-building; reciprocal learning and other benefits of CBPR; navigating the tensions between CBPR and funding priorities; and building an academic setting that supports CBPR. Increasing awareness of CBPR and its benefits, as well as transforming the culture in all spaces where CBPR occurs may maximize its potential to ultimately promote health equity.

This was a retrospective descriptive study of deaths in the Republic of Kiribati from 2005 to 2014. We determined the proportion of all deaths that are ill-defined and described the characteristics of these ill-defined deaths. There were 5618 deaths between 2005 to 2014; of these 1049 (18.7%) were ill-defined. Of these, 576 (54.9%) were male. Those aged 65 years and above had the highest proportion of ill-defined deaths at 40% (n= 415), followed by children aged 0-15 years (29.6%, n=310). Further, 47.7% (n=500) of ill-defined deaths were reported by staff from health dispensaries. When the ill-defined deaths were further categorised according to their R code (with the R code being a group of ill-defined deaths, with sub-groups), 30.5% (n=320) had unknown cause of death, while 29.3% (n=307) had general symptoms and signs. Almost one fifth of deaths in Kiribati were ill-defined, indicating that the reporting on cause of death can be improved through Medical Certification on Causes of Death training and by other means. Improved cause of death reporting will allow the Ministry of Health and Medical Services to better allocate resources, plan health care service delivery and support the development of evidence based preventative and curative policies.

Childbirth is a national priority area for healthcare quality improvement. Patient perspectives are increasingly valued in healthcare, yet Asian American and Pacific Islander (AAPI) perspectives of healthcare quality are often understudied, particularly from individuals with limited English proficiency (LEP). Our study goal was to understand factors that consumers in Hawai'i, including AAPI and those with LEP, use to compare patient care in hospitals, especially for childbirth. A total of 400 women ages 18 years and older with a recent childbirth completed an in-person interview in English (n=291), Tagalog (n=42), Chinese (n=36), or Marshallese (n=31) on O'ahu, Hawai'i. Participants described if (yes/no), and how (open-ended), they believed hospitals in the state varied in providing patient care. Open-ended responses were coded by two independent raters using the framework approach. Respondents were 53.3% Asian, 30.8% Pacific Islander, 13.5% White, and 2.5% other race/ethnicity; 17.8% reported limited English proficiency. Overall, 66.8% of respondents affirmed that local hospitals varied in patient care; Marshallese, other Pacific Islanders, and non-English speakers were significantly less likely to say that Hawai'i hospitals varied in patient care. Among those who endorsed hospital variation, commonly reported themes about this variation were: (1) patient experience, (2) patient overall impression, (3) childbirth options (eg, waterbirths), (4) staff, (5) facilities (eg, "emergency capabilities"), (6) high-tech levels of care, and (7) the hospital's area of focus (eg, "women and children"). We provide insights into factors that diverse patients use to compare patient care in hospitals in Hawai'i to add value, relevance, and engagement to healthcare quality research and dissemination efforts.

There are substantial and persistent health disparities among Native Hawaiians that are best addressed through multilevel socio-ecological approaches, which are tailored to the needs of the community. Partnerships that link academic investigators with grass roots community members have the potential to profoundly reduce health disparities and improve health and wellness by increasing the capacity of community-based organizations to provide leadership in health advocacy, support community health promotion, and participate in health research. We describe a 14-year partnership to reduce Native Hawaiian health disparities between investigators from The Queen's Medical Center and University of Hawai'i John A. Burns School of Medicine (QMC-JABSOM) and community members in Hana, a geographically isolated, underserved, rural community with the second largest concentration of Native Hawaiians in the state. Our relationship started as an investigator-initiated, National Institutes of Health-sponsored study to explore familial cardiomyopathy, and transitioned to a community-based project that combined community cardiovascular health screening fairs with a qualitative research study to understand attitudes towards genetic research. Most recently, QMC-JABSOM has partnered closely with Ma Ka Hana Ka 'Ike, an award-winning construction skills training program for at-risk youth in Hana, to develop innovative, culturally based interventions to improve health and well-being among Native Hawaiians using principles of community-based participatory research.