Ph.D. - Social Welfare

Permanent URI for this collectionhttps://hdl.handle.net/10125/2156

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Obesity and physical activity among Native Hawaiian adults
(University of Hawai'i at Manoa, 2025) Park, Mei Linn N.; Hong, Seunghye; Social Welfare
Obesity poses a significant health concern globally, with Native Hawaiians showing notably high prevalence rates. Historically, physical activity was integral to Native Hawaiian culture. However, modernization has led to sedentary lifestyles, exacerbating obesity rates and health disparities. This Three Article Dissertation (TAD) presents three studies in a cohesive body of work to explore and unravel the topic of obesity and physical activity among Native Hawaiian adults to understand its current state, the disconnects and connections to the past, and how this knowledge can be used to inform future social work practice, policy, research, and education. Study #1 conducts a quantitative secondary analysis of data from the 2017 Hawaiʻi Behavioral Risk Factor Surveillance system. This study aims to describe the relationship between obesity and physical activity among Native Hawaiian adults. The results indicate that physical activity and sex were significantly linked to overweight/obesity among Native Hawaiian adults in the sample, while age, marital status, education, income, employment, and island of residence showed no significant association. Native Hawaiians reported higher rates of obesity, lower levels of physical activity, and those who engaged in physical activity were less likely to be overweight or obese compared to those who did not. Study #2 reviews culturally focused interventions utilizing physical activity to address obesity among Native Hawaiian adults. The purpose of this study is to (a) review the existing literature that focuses on obesity related interventions for Native Hawaiian adults, (b) evaluate the incorporation of culture and physical activity within these interventions, and (c) identify limitations and gaps to promote future research. This study identified nine interventions, revealing wide variations in their descriptions, aims, participants, methods, measures, results, cultural components, and integration of physical activity. It highlighted the necessity for disaggregation and targeted efforts to increase Native Hawaiian involvement and tailored approaches for elder populations, to decrease gender disparities, and to expand statewide locations. Additionally, the study underscored the need for further research on integrating culture into interventions and understanding engagement in physical activity within culturally focused programs. Study #3 aims to explore (a) physical activity facilitators, barriers, motivators, and other factors for Native Hawaiian adults, and (b) recommendations for how physical activity be more available, accessible, and appropriate for Native Hawaiians to achieve health, healing, and wellbeing, by utilizing key informant interviews with community experts. Subthemes include all six dimensions of the Kūkulu Kumuhana framework (i.e., waiwai, ʻāina momona, pilina, ‘ōiwi, and ke akua mana). Suggestions for future actions occurred on all levels of influence 'ohana, community, organizational, and policy. This dissertation can enrich the field of social work by identifying strategies to promote positive patterns of physical activity and understanding how physical activity can be made available, accessible, and appropriate for Native Hawaiians, thus advancing the development of culturally-focused interventions to improve health and wellbeing for Native Hawaiians.
Adverse Childhood Experiences and Resilience Among the Different Generations of Active Duty Military
(University of Hawaii at Manoa, 2020) Garrido, Matthew; Guo, Jing; Social Welfare
The rise in mental health disorders and suicide rates among active duty military (ADM) service members in the last decade prompted a surge in resilience research. Research has shown that exposure to adverse childhood experiences (ACEs) may impact the resilience of individuals and lead to increased rates of mental illness. Recent studies identified that increased suicidal behaviors and risk for the development of mental illness may partly be attributable to the changes in the characteristics of the newest generation of recruits such as lower attention and inhibitory control competencies. Despite the increased attention, few studies have focused on ACEs and resilience among the different generations of ADM. Acknowledging this lack of research, this dissertation study used quantitative methods to examine the profile of ACEs among ADM service members and the relationship of resilience and ACEs among the different generations of ADM service members. The three research questions asked what the profile of ACEs among ADM service members is, what is the association between exposure to ACEs with resilience, and how does generation of ADM impact the relationship between ACEs and resilience. This study draws data from the Warrior Resiliency Study (WRS), which included the demographic information, the ten question ACE questionnaire, and the Connor-Davidson Resilience Scale (CD-RISC) from 250 ADM service members from the U.S. Army. Data were analyzed using R Software for statistical computing of latent class analysis, latent class regression, and moderation analysis. Results of the study found four typologies or subgroups of ACEs among ADM service members that were named Class 1 Low Personal Risk/Low Environmental Risk, Class 2 Moderate Personal Risk/High Environmental Risk, Class 3 High Personal Risk/Moderate Environmental Risk, and Class 4 High Personal Risk/High Environmental Risk. Using latent class regression, resilience predicted membership for Class 3 and Class 4. Moderation analysis was conducted to examine the interaction between ACEs and age on resilience. The results showed that, at a specific age range (26.67 to 31.25 years), the impact of ACEs on resilience was greater with more ACEs. The results confirm the significance of any ACEs and high ACEs (3 or more) as predictors of resilience. Additional moderation analysis was conducted to examine the interaction between ACEs and generation on resilience. The non-significant interaction findings between ACEs and generations showed differences between Generation Z when exposed to a high number of ACEs (3-10) than their older generational cohorts. Overall, the results of this study point to the importance of examining ACEs for resilience and suggest that certain subgroups of ADM service members may need additional support as they continue with military service and rise in rank and responsibility. The results also point to the importance of examining ACEs and resilience among different generations and offer directions for future research on measuring generations among this population as increased number of Generation Z join the military as new recruits.
Understanding Caregivers of Native Hawaiian Kūpuna with Age-Related Memory Loss on One Hawaiian Homestead
(University of Hawaii at Manoa, 2018-08) Dillard, Adrienne Y.; Social Welfare
Understanding the concerns and challenges of caregivers of Native Hawaiian kūpuna or elders (age 55 years and older) with age-related memory loss conditions, specifically, Alzheimer’s Disease and Related Dementia (ADRD), on one Hawaiian Homestead is the focus of this doctoral research study. ADRD is known to affect memory, thinking, and behavior. This research is grounded in Community-Based Participatory Research (CBPR) principles and utilizes a mixed methods strategy to assess the needs and concerns of caregivers. This mixed methods study utilizes a quantitative arm of the study involving development and administration of a written survey eliciting sociodemographic characteristics, as well as knowledge-attitudes-behaviors on caregiving. The qualitative arm of the study is with focus groups intended to clarify and extend information learned through survey data. Study findings can assist a homestead community in determining the types of resources and support essential for long-term care to mitigate caregiver burnout and simultaneously provide services that enhance kūpuna care. Results will inform providing safe, compassionate, community-based culturally appropriate care in the community for kūpuna who prefer to age in place. This dissertation research aligns with the focus of social welfare on health equity and cultural competence focusing on Native Hawaiians, a marginalized population and the need to provide relevant ADRD services for all. Further, this research contributes to the growing literature on aging in place from an Indigenous (Native Hawaiian) cultural perspective. This research underscores the importance of community “self”-determination. Specifically, study results indicate the cultural preference is caring for kūpuna is a community kuleana (responsibility). By extension, there is a need for community training that strengthens the capacity to address this kuleana. Current and emerging community leaders from across the generational continuum would benefit from training that ensures community participation in identifying moreover, addressing kūpuna needs, as served in a spirit of caring and excellence. Findings from this study are community-specific and cannot be generalized to all Native Hawaiians and Native Hawaiian communities. Research performed in one urban homestead community may provide critical considerations for others interested in developing policy and research for/with elders and family caregivers in the context of ADRD.
Gender, Perceived Health Status, and Social Support Amongst Oahu's Homeless
(University of Hawaii at Manoa, 2018-05) Perumal, Vijaya; Social Welfare
Homelessness has been increasing on Oahu for the past several years. The health status of the homeless, sheltered population is unexplored because of the challenges in gathering data about their situations. This exploratory research has detailed the sociodemographic profile of this group, exploring the impact of race/ethnicity, gender, class, age, parental status, length of homelessness (LOH), and social support on the perceived health status of the homeless, sheltered population on Oahu, Hawai`i. This research surveyed 151 participants living in four shelters: two in urban and two in rural settings. The research explored the perceived health status, availability of social support and length of homelessness (LOH), respectively, using the Center for Disease Control (CDC)’s Healthy Days Core Module (HDC), Interpersonal Support Evaluation List (ISEL), and Length of Homelessness survey (LOH). The three models, the general health, physical and mental health statuses were analyzed using bivariate analysis, ordinal logistic regression, and negative binomial regression models. The results suggest that Micronesians are more likely to have fewer physically and mentally sick days than their White counterparts within the homeless population. It appears that Micronesians migrating from collectivistic society share similar cultural values and burdens of homeless situations. In contrast, the White participants with individualistic values face the challenges alone. Sheltered women are more likely to have poorer mental health status than men. The physically sick days model indicated that social support had a negative, not positive, impact on a participant’s health status. Implications for future research to focus on the type and frequency of social support resources that work well for Micronesians and explore the mechanism that will work well for the White participants.
Juvenile Sex Trafficking and Hawai'i Public Policy: Examining the Policy Image of Juveniles Involved with Commercial Sexual Activity in Hawai'i
(University of Hawaii at Manoa, 2018-05) Marshall, Sarah M.; Social Welfare
Juvenile sex trafficking is a grave social problem that involves the commercial sexual exploitation of children. At the beginning of 2016, Hawai‘i ranked among the states with the least amount of protective legislation for juvenile sex trafficking victims. A potential factor contributing to this state-level response was the way in which the issue was discussed and framed within Hawai‘i’s public communications. The purpose of this dissertation was to examine the policy image created within the communication frames used by policy elite actors in Hawai‘i. This study drew data from two distinct sources: Hawai‘i’s major newspapers (n = 102 articles) and written testimony submitted to the Hawai‘i State Legislature (n = 399 testimony). A mixed methods content analysis was utilized to analyze the data. Analysis was guided by framing theory and was based upon Entman’s four-part typology: problem definition, causal interpretation, moral evaluation, and policy recommendation. Specific attention was paid to the use of episodic and thematic frames. Within the newspaper article data set, the overall policy image of juveniles was a variable one. Most often an image of juveniles as victims of sexual exploitation was used (45%), although in almost a quarter of the articles (22%) juveniles were clearly portrayed as criminals, and in a third of the articles (33%) juveniles were portrayed as both criminals and victims. Within the legislative testimony data set, the overall policy image of juveniles involved with commercial sexual activity was unmistakably an image of juveniles as victims of sexual exploitation (90%). A gradual shift in the policy image of commercially sexually involved juveniles is emerging within Hawai‘i’s public communications. Juveniles are increasingly being framed as victims of sexual exploitation rather than as criminals offending society. A key conceptual change necessary for disrupting exploitation and addressing juvenile need is to view juveniles as victims deserving of social aid rather than as criminals undeserving of social aid. The trend that is emerging in Hawai‘i’s major newspapers and in State legislative records seems to indicate that this key conceptual change is occurring within the communication frames used by Hawai‘i’s policy elite actors.
Mental Health Service Users As Peer Providers In Hawai‘i: Understanding Recovery Paths And Perspectives
(University of Hawaii at Manoa, 2018-05) Rocchio, Christopher; Social Welfare
The purpose of this study was to examine the lived experiences of Hawaii’s mental health service users in becoming certified peer providers. Qualitative methods were used to understand the perspectives of eight (8) mental health service users trained and credentialed through the Hawaii Certified Peer Specialist (HCPS) program. Data were analyzed at two levels. At the first level, an inductive approach using grounded theory identified four themes across participants: (1) prior to training and certification, the prospect of participation instilled hope of moving forward in their own recovery and helping others with similar lived experiences; (2) subsequent to training and certification, the lack of follow-up support services and few employment opportunities resulted in feelings of frustration and hopelessness; (3) ongoing systemic stigma and discrimination maintain barriers to integration; and (4) completion of the program increased their confidence, decreased their feelings of isolation, increased their empathy towards others with mental illness, and broadened their perspectives and worldviews. At the second level, themes from the first-level analysis were examined through the lens of Critical Disability Theory. Together, the first and second-level analysis provide unique insights into potential motivation factors for Hawaii’s mental health service users applying to the HCPS program. Findings also highlight organizational barriers that hinder the integration of peer providers as employees in traditional mental health service settings. Implications for policy, social work practice, and future research are discussed.
Colorectal Cancer Screening among Chamoru on Guahan: Barriers and Access to Care
(University of Hawaii at Manoa, 2017-08) Diaz, Tressa P.; Social Welfare
Colorectal cancer (CRC) is the second most common cause of cancer death on Guahan (Guam). Chamoru, the Indigenous peoples of Guahan, have the highest mortality rates in CRC on island, which implicates the need for earlier detection. Limited research has been conducted on CRC screening behavior among Chamoru. To address the gap, this study seeks to understand, explore, and predict factors associated with CRC screening among Chamoru, and to address the research questions: (1) How does access to care impact colorectal cancer screening among Chamoru on Guam; and (2) What are barriers to colorectal cancer screening among Chamoru on Guam? Guided by Andersen’s Behavioral Model of Health Service Utilization, individual predictors were categorized as predisposing, enabling, and need factors that facilitate or hinder CRC screening. A mixed quantitative and qualitative methods approach was utilized. First, screening data from the 2010 Guam Behavioral Risk Factor Surveillance System were used to model the association between CRC screening and predisposing, enabling, and need factors. Second, semistructured in-depth interviews with Chamoru men and women were conducted on why they opted for or against CRC screening. Purposive and snowball sampling was implemented to recruit participants due to the potentially sensitive and stigmatizing subject of colon/rectum screening processes. Binary logistic regression was used in quantitative analysis to determine significant predictors of CRC screening utilization. Qualitative analysis implemented Grounded Theory to determine relevant themes and key findings. Quantitative results show that having an annual check-up and educational attainment of high school or greater significantly predicted CRC screening. Qualitative analysis points to five themes in CRC screening decision-making: (1) being proactive in one’s healthcare; (2) intergenerational consciousness of cancer diagnosis and related screening behaviors; (3) social stigma associated with colonoscopies; (4) “If I’m vi i gonna die, I’m gonna die”; and (5) negative perceptions of the medical system. Findings provide insight toward cultural and health beliefs as facilitators and barriers to CRC screening with broader implications for political status as a determinant of health. Further research toward culturally tailored screening interventions is recommended to address cancer disparities in the context of healthcare access and health equity for Chamoru.
Identification and Prediction of Child Behavior Trajectories among Children Who Have Experienced Maltreatment.
(University of Hawaii at Manoa, 2017-08) Alboroto, Richard B.; Social Welfare
Background. Child maltreatment affects almost 683,000 children annually. The consequences of child maltreatment range from physical and mental health issues, at the micro-level, to increased child welfare worker caseloads and overcrowded residential facilities at the mezzo-level, to increased costs and policy implications at the macro-level. Children who have been maltreated are at-risk for behavioral problems, yet little is known about the diverse problematic behaviors of these children or main factors causing behaviors. This study aims to identify internalizing and externalizing behavior pathways that follow over a 6-year period, and the predictors of membership in problematic pathways. Methods. Growth Mixture Modeling (GMM) was used to estimate the number of subgroups of children following distinct behavioral pathways. Standard T-scores from the CBCL subscales were entered into a series of unconditional GMM models. BIC, BLRT, and entropy were examined when considering model fit. Multinomial logistic regression was conducted to identify predictors of problematic behaviors over time. Results. There were no unconditional models that fit the data best. Several statistically significant (p < 0.05) factors at the level of the child, caregiver/parent, and environmental influence children’s problematic behaviors. Controlling for all other model variables constant, male children are more likely to exhibit behavioral problems than female children. Children with low social skills are more likely to engage in problematic behaviors. Caregivers with little or no support are more likely to report having children engaged in delinquent behavior. Finally, access to social services significantly lowers the children’s problematic behavior over time. Conclusions. Children differ regarding how they respond to maltreatment and other life events or situations depending upon child, caregiver, and environmental factors. Study results indicated that these factors influence the problematic behaviors of maltreated children. Study results also indicated that improving maltreated children’s social skills and increasing caregiver social support may be key in reducing child behavior problems. Furthermore, identifying early indicators of internalizing and externalizing behavior problems and addressing them with evidence-based interventions to reduce negative behaviors may avert long-term negative outcomes. Limitations of this current study are reviewed; practice and policy implications are discussed as are recommendations for future research.
Examining the Determinants of Colorectal Cancer Screening Practices among Asian Americans
(University of Hawaii at Manoa, 2017-05) Kim, Sophia B.; Social Welfare
Asian Americans (AA) are documented to have low colorectal cancer (CRC) screening rates. Recent studies have further revealed screening disparities among AA subgroups. Focused research on CRC screening among AA subgroups are needed to more effectively address the CRC burden experienced by this growing racial/ethnic population. The purpose of this dissertation was to examine the determinants of CRC screening among AA. Study 1 was a systematic review of the determinants to CRC screening among AA subgroups using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study 2 used the 2012 Hawai‘i Behavioral Risk Factor Surveillance System dataset and examined the associations between CRC screening and ethnicity, controlling for socio-demographic and healthcare variables using multiple logistic regression. Study 3 used the 2009 California Health Interview Survey dataset and examined the associations between physician’s recommendation and ethnicity, controlling for socio-demographic, cultural, and healthcare related variables using multiple logistic regression. All reported odds ratios were considered statistically significant at the p ≤ 0.05 level. Study 1 found different determinants to CRC screening between the AA subgroups. Study 2 revealed ethnic and gender variances in CRC screening among the AA subgroups. Chi-square analyses showed gender variances in CRC screening among the total women sample and Japanese compared to their respective counterparts. Multiple logistic regression results further revealed ethnic and gender variances in CRC screening even after controlling for other covariates. Study 3 revealed that having high limited English proficiency decreased the odds for physician’s recommendation for Chinese; being employed decreased the odds for Filipino; and having insurance decreased the odds for Korean. Wide array of determinants influence AA subgroups’ colorectal cancer screening practice (CCSP). Implications for policy, social work practice, and future research are evident from this dissertation. Researchers should remain cognizant of unique factors that play an influential role in subgroup’s decision to complete CRC screening; and further investigate potentially important but understudied and misunderstood determinants of CCSP presented in this dissertation. In turn, intervention efforts should be tailored to highlight the cultural strengths of each distinct subgroup and to address their unique needs and barriers to CRC screening.
A Study of Immediate Sanction Effectiveness to Reduce New Conviction Post-Probation
(University of Hawaii at Manoa, 2016-05) Sensui, Leonard
The criminal justice system’s attempt to reduce new conviction of drug using individuals, through incarceration, has increased the national prison population rate by 3.2% from 1.526 million in 2005 to 1.575 million in 2013; also, between 2001 and 2013, more than 50% of federal prisoners were convicted of drug charges (Rabinowitz & Lurigio, 2009; Carson, 2014). The average cost to incarcerate an individual in Hawai‘i is about $44,895 annually (Lawrence, 2016). Nationally, in order to reduce the prison population and the associated costs, more individuals were placed into probation supervision. Research has shown that first and second time offenders who received probation supervision instead of prison terms were less likely to recidivate (Rabinowitz & Lurigio, 2009). However, according to Mauer (1999), as probation caseloads increased, individual supervision time declined, which caused drug using violations and non-compliant behaviors to increase. In order to increase probationers’ compliance levels, the First Circuit Court in the county of Honolulu (O‘ahu) incorporated a probation supervision model based on the theory of operant conditioning. The model included motivational interviewing techniques (to increase probationers’ good behaviors) and incorporated immediate sanctions (to reprimand probationers’ noncompliant behaviors). This study analyzes factors related to new convictions and it includes comparisons of supervision outcome of probationers who began 5-years of probation supervision between the periods of January 2007 through December 2007. Probationers’ supervision outcomes and new convictions were examined until December 2014. The post-probation outcome of reducing new conviction was significantly effective when immediate sanction was employed as a supervision mechanism. This research may provide valuable information to the social work field to improve probationers’ compliance, drug treatment outcomes, and to increase public safety through the reduction in drug related crime.
An Examination of Predictors of Sexual Assault Mental Health Treatment Utilization in Asian American, Native Hawaiian, and Caucasian Sexual Assault Survivors
(University of Hawaii at Manoa, 2016-05) Nelson, Dawna
Many survivors of sexual assault experience detrimental effects as a result of the assault. Mental health treatment targeted towards sexual assault is a viable, but often underutilized resource for the treatment of posttraumatic stress symptoms post-assault. Unfortunately, there is a lack of information about what factors contribute to sexual assault mental health treatment utilization in diverse populations. The populations commonly examined in studies on treatment utilization are primarily Caucasian samples. Native Hawaiians and Asian Americans are commonly excluded from or misrepresented in research seeking to identify predictors of mental health treatment utilization. The purpose of the current study was to examine if factors theorized to predict treatment utilization in primarily Caucasian samples are equivalent and/or relevant in Asian American and Native Hawaiian groups. This is the first study to examine sexual assault service utilization using a sample inclusive of Caucasians, Asian Americans, and Native Hawaiians. Utilizing data from a community agency that serves survivors of sexual assault, I conducted a multigroup confirmatory factor analysis approach to explore factors theorized to predic treatment utilization. Overall, factors theorized to predict treatment utilization were not significant among the sample as a whole or by ethnic racial group. However, significant differences in trends related to treatment utilization were identified. Native Hawaiians used significantly fewer services than Asian Americans, emphasizing the importance of proper representation of these two unique ethnic/racial groups in research. Findings from this study have important implications for future research and practice in the field of social work.
Learn to Swim: A Mixed Methods Approach to Understanding How Social Work Experiential Education Impacts Students' Social Justice Attitudes
(University of Hawaii at Manoa, 2015-12) Branson, Candy
The purpose of this research is to advance the knowledge of social work education by addressing a portion of the Council on Social Work Education’s (CSWE) 2012 accreditation standard 2.1: How does field education connect the theoretical and conceptual contribution of the classroom with the practice setting? This study examines connections among theoretical and conceptual social justice contributions of the classroom (abstract learning in a classroom) with the practicum settings (concrete field experiences) and explores how these contributions influence social justice attitudes. Recognizing social work education as an experiential education setting with a social justice aim, this study builds on previous research by: 1) assessing the association between demographics and other predisposing factors that may influence social justice attitudes, and 2) comparing changes in social justice attitudes (prior to a practicum experience vs. after one academic semester of practicum). Using a pretest posttest design, social justice attitudes of 35 Bachelor of Social Work Students (BSW) enrolled at a university within the Asian-Pacific region were examined using the Social Justice Scale (SJS) (Torres-Harding, Siers & Olsen, 2012) and the Civic Engagement Questionnaire (CASQ) (Moley et. al., 2002). The survey results were analyzed using multiple split-plot analyses of variance (ANOVAs) and subsequent t-tests. Predicted differences in social justice attitudes were not supported nor were predicted differences in social justice attitudes based on gender, concurrent volunteer service, and experiences with previous social injustices. However, differences in race were found. In Wave 2 of this study, phenomenographic analysis was used to analyze the focus group data of 7 students who also participated in the survey. The analysis identified students’ conceptions of learning about social justice. Four emergent categories include: Uncertainty, Existing Values, Realization, and Transformation. Content analysis revealed active participation as a learning method that students prefer. These findings may facilitate educators in social work and community programs to more effectively design curriculum that produce educational outcomes that are consistent with students’ conceptions of social justice learning.
The Impact of Gender and Cultural Factors on the Patterns of Elder Care Service Utilization among Family Caregivers of Japanese Ancestry in the State of Hawai‘i
(University of Hawaii at Manoa, 2015-05) Sato, Seiko
Various types of elder care services have been developed to accommodate the needs of older adults and caregivers; however, what factors affect service use decisions are mostly unknown, especially among racial/ethnic minority groups. The purpose of this study was to examine how gender and cultural factors affect elder care service utilization among caregivers of Japanese ancestry in the State of Hawaiʻi. A 2-stage mixed method design, including quantitative and qualitative approaches, was utilized. For the quantitative stage, a secondary data analysis was conducted based on a sample of 151 (115 females and 36 males) Japanese caregivers in Hawaiʻi to examine the impact of caregiver gender on service use patterns. Independent t-test results indicated female caregivers used a greater amount and a wider range of services than their male counterparts. Multiple regression results indicated caregiver gender still remained as a statistically significant predictor of service utilization after controlling for other predictors (e.g., education level and living arrangement). For the qualitative stage, one-time semi-structured interviews were conducted with 23 Japanese caregivers in Hawaiʻi to examine the impact of culture on service use patterns. Seven themes emerged in the process of content analysis by using grounded theory. The major qualitative finding was that both cultural and non-cultural factors influenced the service use decision-making, but non-cultural factors (e.g., caregiver’s work) were essential determinants of service use. In practice, social workers need to pay attention to the dyadic relationship between caregivers and care recipients when it comes to service use decision-making. Each culture shapes certain ways to perceive caregiving; therefore, understanding cultural values/beliefs of caregivers and care recipients helps social workers to suggest appropriate service options. As for future elder care systems, educating male caregivers on elder care services, providing language support for foreign-born caregivers and care recipients, and improving current transportation services are suggested.
Organizational change in the aging network to promote evidence-based programs
(University of Hawaii at Manoa, 2013-08) Tomioka, Michiyo
Demand for preventing, delaying the onset of, and managing chronic diseases has escalated. Attention is being given to expanding replication of evidence-based programs, those proven to work, to address chronic disease. Although federal agencies encourage communities to adapt evidence-based programs, studies on how organizations learn about and adapt such programs are limited. The purpose of this research was to develop a roadmap for adapting the Chronic Disease Self-Management Program (CDSMP). Findings are based on five years of experience of the Hawaiʻi Healthy Aging Partnership (HHAP), a statewide coalition devoted to replicating evidence-based health promotion programs for older adults. Planned adaptation theory and life cycle theory guided the exploration of processes in adapting, replicating, and sustaining CDSMP in eldercare providers in Honolulu, Hawaiʻi. Using an embedded case study design, this dissertation study collected data from multiple sources (including documents, interviews, and questionnaires) from three levels of participants (state/county offices, service providers, and program participants) at three phases of program adoption (initiation, delivery, and sustainment). Findings describe conditions that contribute to or hinder organizational functioning in adapting, delivering, and sustaining evidence-based programs. Necessary ingredients are continuous support from government and strong coalition infrastructure. Successful adapters also had: 1) on-the-ground champions who examined program content, identified and applied modifications, had on-going commitment, adapted evaluation strategies, perceived benefits of the program, and worked well with other organizations; 2) organizational champions, including supervisors, who bought-in to the program and perceived its fit with the organization; 3) sufficient organization capacity, including willingness to contribute or seek funding, develop internal champions, and market the program; and 4) good interactions with external organizations that could provide technical assistance or attain potential participants. The theory-based framework developed to guide this dissertation study was supported by the data, but findings suggest ways to strengthen the framework. An 11-step guide for the initiation, delivery, and sustainment of CDSMP adoption by government officials and service providers emerged. These proposed guide should be helpful to other communities that want to adapt CDSMP, however it should be further tested to validate its usefulness in non-Aging Network coalitions and for other evidence-based programs.
In search of Ainu voices for the future generations: "usa okay utar uaynukor wa, pirka horari, sasuysir pakno situri kuni"
(University of Hawaii at Manoa, 2013-05) Okada, Mitsuharu
The Japanese government recognized the Ainu as an indigenous people of Japan in 2008. Over a hundred years of discriminatory assimilation policies have impacted erosion of the Ainuʻs cultural values and traditional ways of living. Very few studies on the Ainuʻs awareness and perspectives on their status, current situations cause lack of the knowledge in Japanese society about Ainuʻs challenges. The overarching research questions are: 1) In light of the government recognition in 2008, how do the Ainu perceive their standing as a people (culturally, politically, and individually)?; 2) What are the opportunities and challenges for the promotion of the rights of the Ainu as an indigenous people?; and 3) What are the hopes for future generations? Utilizing qualitative methodology, fifteen Ainu people were interviewed to grasp the topic focus of Ainu individuals. Significant findings which emerged from the study are: 1) Japanese government policies document more than one hundred years of disruption of Ainu ways of living, values, and cultural traditions the impact of which we are just beginning to understand. 2) As a result of this determined destabilization, Ainu represented in this study do not have a unified position. 3) Ainu values and ways emphasize living in harmony with nature and other beings, and therefore, have not developed a warrior tradition. This has left them open to Japan's past nation-building ambitions. 4) Study participants realize there are numerous issues that need to be resolved in order to advance their aspirations for cultural restoration. Analysis of policies and participant interviews, suggest that honoring, teaching and applying the Ainu values and worldview to contemporary living may be inextricably tied to the Japan's future relevance and survival in a changing world. This transformation may be accomplished, for example, by strengthening the country's governance through inclusion of diverse worldviews, and recognizing the importance of indigenous peoples' practices in sustaining well-being. Based on these findings, recommendations offered include: Reforms in national policy and education, the growth of leadership within the Ainu society, and access to guidance from other indigenous groups, and relevant consultants.
Assessing our youth: clinician perceptions of assessment practices with adolescents in substance abuse treatment
(University of Hawaii at Manoa, 2013-12) Fox, Colleen Margaret
This study documents the assessment practices of substance abuse counselors working with adolescents, to understand how these clinicians use information gathered during the assessment process, and to determine what factors influence counselors' use and perceived value of assessment data. The project helps to better understand assessment practices and, by implication, how these practices have been shaped by supervision and training, policy, culture, and other factors. Substance abuse assessment is the process of gathering information about an individual in order to identify the presence of substance abuse-related problems, placement and referral needs, and any additional problems to be addressed. Once the assessment is complete, the best practice in the field is to summarize the data gathered and use that information to create a treatment plan, which then guides the treatment process. A concurrent triangulation mixed methods design was used. Quantitative surveys and qualitative interviews were conducted with substance abuse counselors in Hawaiʻi serving adolescents. The theoretical basis for this study was Social Cognitive Theory, which conceptualizes counselors' engagement with the assessment process through the reciprocal interaction of environmental, personal, and behavioral determinants. The research findings indicate that assessment tools need to be appropriate and engaging for adolescents, with an emphasis on keeping the assessment brief and using language that is easy for youth to understand. It is important to encourage openness, honesty, and trust with youth by helping them know what to expect in the process and by explaining confidentiality. The assessment process is valuable for gathering information, as well as building rapport, establishing roles, and increasing the client's motivation. The domains of drug and alcohol history, family, peer/social relationships, and school background were identified as the most valuable sources of information and were also most frequently integrated into treatment planning. Experience, supervisory valuation of assessment, and role were associated with the valuation of assessment, while agency valuation of assessment was associated with use of assessment data. Based on these findings, recommendations for policy, education and training, stakeholder engagement, instrument development, and youth engagement were identified.
An examination of the evolution and implementation of Native Hawaiian cultural practices in the treatment of adult substance use or co-occurring mental health and substance use disorders: an organization case study
(University of Hawaii at Manoa, 2012-05) Lee, Michael John Palama
This case study examined the implementation of Native Hawaiian Cultural Practices (NHCPs) to understand why and how one organization identified, developed, and implemented these practices to address substance use or co-occurring mental health disorders among Native Hawaiian adults, and key factors that impact the implementation process. Qualitative methods used included semi-structured interviews, focus groups, review of documents and archival records, and casual observation. Study participants were recruited from a community-based organization that used NHCPs and Western addiction practices in the treatment of substance use. Participants included administrative staff (n=4), program staff (n=5), and Native Hawaiian consumers (n=15). Content analysis was used to identify 488 codes, 23 subthemes, 3 themes, and 1 overarching theme. The three themes (key factors) identified included: 1) Pilialoha or loving relationships people maintain with each other, with places, and with spirituality, 2) Kohoʻia or identity as a predestined concept, and 3) ʻĀkoakoa or organizational integration that acknowledges similarities, differences, and areas in which Hawaiian and Western cultures blend. As the overarching theme, Piliʻana or connections characterize the Hawaiian universe as a continual movement of asking permission, engaging, and mutual benefit binding people, land, and spiritual realms together. Other key findings included: wahi pana or place-based knowledge and resources such as the significance of cultural kūpuna or elders, relational harmony such as pono or morality and justice and lōkahi or unity, the expansive nature of values that reinforce an individual‟s connection to communal life, the transferability of a healthy code of conduct from ʻāina or land interactions to human interactions, an extended period of time to plan with communities, the influential role of organizational leadership in diffusion of an innovation, and spirituality and faith as important implementation factors. These findings suggest social workers have an opportunity to implement novel programs responsive to the cultural needs of indigenous populations at greatest risk for substance use or co-occurring disorders by incorporating their epistemic worldview to increase program utility, improve recovery outcomes, and facilitate healing. At the same time, social workers must continually assess organizational key factors that impact the implementation of an innovation to become routine practice.
Challenges and strengths influencing adjustment and marital satisfaction for immigrant women who married Korean men in Korea
(University of Hawaii at Manoa, 2012-12) Choi, Mihye
The purpose of this study is to identify challenges and strengths influencing adjustment and marital satisfaction of immigrant women who married Korean men in Korea. This study, by identifying immigrant women's strengths, could help them to find greater enjoyment in their lives and have the ability to achieve a better life. This research uses three theoretical perspectives, acculturation phenomena, family relationships, and social environment, to provide a better understanding of immigrant women's adjustment and their married life. With this purpose, sixteen immigrant women and two of their husbands were interviewed in depth. The marriage period of all participants ranged from three to twelve years. In their marital experience, participants identified four stages: first, they may find themselves isolated; second, they realized and accepted the reality of their situation; third, they felt stable and settled; fourth, their life improved, and they were optimistic and hopeful about their future. The results of the study showed the following strengths for these immigrant women that have enabled them to sustain their married life and acculturation to Korea: 1) their self-esteem as an emotional and individual resource seemed to have a positive impact on their marriage and life; 2) these women seemed to have cultural advantages that made the acculturation to the Korean society easier; 3) most of the women exhibited characteristics such as dedication, patience, and acceptance after experiencing confusion and conflicts in the beginning; 4) the familial, social, and governmental support system served as a great help in that they discovered a breakthrough or a resolution for their problems; 5) the positive attitude of these women towards their lives in Korea was one of their strengths; 6) their willingness and desire for social participation was another advantage; 7) these women had a future-oriented attitude, allowing them to dream about the future despite their difficulties; and finally 8) these immigrant women seemed to be future workers full of the potential to raise multicultural families and to become positive role models for other immigrant women.
Examining disparities in compliance in appointment keeping among older adult's with diabetes mellitus type 2 within a managed care setting
(University of Hawaii at Manoa, 2014-12) Wakida, Richelle Michie
Health disparities are documented among Hawaiʻi's multi-ethnic adult population diagnosed with diabetes mellitus type 2. The findings of the current study suggested the HMO model in the State of Hawaiʻi may be potentially effective in addressing racial/ethnic disparities in compliance. In terms of age and compliance in appointment keeping, findings suggested that disparities continued to exist even among patients who have medical insurance coverage as well as access to health care. Taken together, these findings have important implications for social policy and practice. The findings of the study have demonstrated that racial/ethnic disparities can be alleviated in certain health care settings with the appropriate practices in place. For example, Kaiser Permanente's integrated approach with a client centered focus may have important implications in care delivery in terms of provider-patient relationship, communication, and treatment of racial/ ethnic older adults diagnosed with diabetes mellitus type 2. This study contributed to the knowledge in disparities in health and health care as well as factors affecting compliance in appointment keeping. Moreover, it formed the foundation to which other studies may be predicated on in the future.
Native Hawaiian Homestead residents' perceptions of cultural safety in community-based health research
(University of Hawaii at Manoa, 2014-12) Tamang, Suresh
Background Native Hawaiian communities have consistently expressed distrust and raised concerns about their participation in research programs that disregard the cultural norms. Thus, they are reluctant to participate in conventional research. Objectives The purpose of this study was to describe Native Hawaiian Homestead residents' perceptions of "cultural safety" and assess perceptions that may affect this group's participation in research. Methods Qualitative data were collected from three purposively selected Hawaiian Homestead communities, Wai'anae, Papakolea, and Waimanalo (N = 27 adults). Three community cofacilitators were recruited and trained in qualitative research methods. Five focus groups and five key informant interviews were conducted. All participants completed a social-demographic survey. Data were audio-recorded, transcribed, and coded. Data analysis involved a content analysis and co-analysis with the community co-facilitators. Results Six major themes emerged, including that upstream factors influence perceptions of cultural safety, that attention to the ethical values of Hawaiian culture and Homestead communities promotes cultural safety, that culturally safe research reflects "culture" as multi-dimensional, that community empowerment is intricately linked to cultural safety, that cultural safety is relationally-based, and that safety is wholistic with systemic and community factors influencing personal perceptions. Conclusions Native Hawaiian Homestead residents were skeptical about conventionally conducted research that disrespected their indigenous culture and that ignored public engagement. Therefore, cultural safety is a relevant concept for promoting the active engagement of residents in research that honors the cultural preferences. The cultural safety framework also facilitates the dignity, justice, and wellbeing of Hawaiian Homestead residents. Implications Ethically designed and culturally safe research provides the right evidence and direction for appropriate and locally-fit solutions. Social welfare and health research interventions will be effectively implemented in Native Hawaiian communities if they are culturally safe. Cultural safety training will be useful for building the capacity of policy-makers, researchers, and professionals. Researchers will pay attention to cultural safety aspects, be respectful and sensitive to the culture. Agencies such as universities, hospitals, and schools will develop culturally safe policies and design unique programs that meet the need of indigenous peoples, including Native Hawaiians. They can recognize their responsibilities of readdressing the "unsafe" policies and practices by redistributing the power and resources.

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