Mālama nā makua I nā keiki me ka hānō: Native Hawaiian parents caring for their children with asthma

Abstract

Background Native Hawaiian children have the highest prevalence rate of asthma among all ethnicities in the State of Hawaiʻi. Literature is limited regarding Native Hawaiian parents' perception and experience caring for their children with asthma in the context of uncertainty. Nurses require more information and theoretical guidance to competently assist Native Hawaiian parents in asthma care. Objective The purpose of this study is to explore contemporary Native Hawaiian parents' perspective and experience of caring for their children with asthma in the context of uncertainty. Method Descriptive qualitative approach by means of directed content analysis using focus groups was applied to this study. Focus groups were likened to "talking story," a familiar method of sharing information among Native Hawaiians. Eight open-ended questions elicited asthma history, asthma management, and how the Hawaiian culture affects parents' health practices. Directed content analysis applied Mishel's Uncertainty in Illness Theory (UIT) to guide data collection, organization, and analysis. Results The concept analysis of uncertainty and literature review confirmed the application of the concept among multiple disciplines. Interview data were organized into the UIT constructs, categories and subcategories. New subcategories related to asthma care (lack of asthma experience and asthma triggers) and culture (differentiation between Western therapies and complementary alternative medicine) were identified. Parents' personal stories and accounts provided rich data. The study's findings verified that Native Hawaiian parents experience uncertainty regarding asthma care as commonly described in literature. Contextual influences including indigenous worldview and cultural values affected Native Hawaiian parents' perceptions and experiences with conventional asthma care. Unique findings involved the etiology of asthma and features of social support ('ohana). Conclusion Nurses are in a strategic position to alleviate Native Hawaiian parents' experience of uncertainty regarding asthma care. Nurses will find the application of the UIT constructive when working with Native Hawaiian parents because their unique perspectives and experiences can be better assessed and understood. As nurses become more knowledgeable about indigenous viewpoints including cultural values and preferences, they will be able to assist Native Hawaiian parents in a familiar and acceptable manner. Future implications for research, nursing practice, and policy have been provided.