Exploring Factors Relating to Preventive Cancer Screenings for Native Hawaiian and Pacific Islander Adults
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2024
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Native Hawaiian and Pacific Islander (NHPI) populations experience adverse health consequences due to unequal access to health promoting resources such as money, power, prestige, and knowledge/education. These communities are further hindered by sociocultural, geographic, and environmental factors that contribute to cancer health disparities. Thesepopulations face increased cancer incidence and mortality rates. However, further insight into influences on preventive health such as cancer screenings is needed. This dissertation examines sociological, psychological, and public health theoretical and conceptual frameworks explaining preventive health service utilization within these groups. This study utilizes a mixed methods approach to examine influences to cancer screenings through the use of a secondary data analysis of a 2017-2018 Hawaiʻi Health Information National Trends Survey (HINTS) and 16 semi-structured interviews conducted in the State of Hawaiʻi. Interviewees were recruited from two of the public housing site locations of the original survey consisting of Native Hawaiian, Chuukese, and Marshallese adults. An aim of this study is to triangulate findings from both a regression analysis and a thematic analysis of the interview findings to determine social factors that
influence cancer screening behaviors. Another aim is to highlight the social drivers of health behaviors that one methodological approach might not have captured. Health comprehension, acculturation, and perceived racism/mistrust in healthcare were social factors of interest as demonstrated by influential causes from in the literature. These social factors are measured within a regression analysis fitted through the use of an expanded Andersen Model, Behavioral Model for Vulnerable Populations, to highlight cultural influences that might not be measured in more limited models. These social factors are also integrated within the interview guide used for discussion points. Results show that health comprehension barriers include language barriers and misunderstandings due to a cultural norm of being uncomfortable asking doctors questions or a fear of being seen as unintelligent or not informed about healthcare options. Individuals who hold a neutral acculturation to both their ethnic culture and Western culture are less likely to be screened for cancer. Within public housing, inter-group views are held, as many Native Hawaiian interviewees felt that other Pacific Islander groups engage in unhealthy behaviors and lifestyles. A sense of fighting for resources between groups within public housing surfaced from
these findings. Those who have not experienced racism are more likely to be screened for two of the cancers. The interviewees mainly discuss mutual respect with their doctors and positive interactions with their providers. Chuukese women speak of stories of others within their community who felt they were treated differently in healthcare. From the interviews, major themes emerged in that NHPIs fear cancer and other concerns such as being treated differently if they were to be diagnosed and anxieties surrounding a fear of the unintended costs of screenings. All of the interviewees highlight a belief in a higher power and that God is in control of their life and health. This demonstrates the role of God and faith in decision making for NHPI communities. Small, close circles where informational exchanges take place mainly consist of family and cohabitants. There is a lack of strong social ties and networks to other NHPI communities and organizations that could facilitate the use of health-based resources. Additionally, family members are not discussing health or family histories of disease. All of which is instrumental in early detection of illnesses and screening behaviors. NHPI populations feel a need to prioritize their family above their own needs, and are not engaging in self-care such as cancer screenings. This dissertation contributes to the understanding of the health of NHPIs and adds to the fields of medical sociology and public health by highlighting social processes found to be influential to NHPI cancer screening behaviors in Hawaiʻi.
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Sociology, Cancer, health disparities, mixed methods, Native Hawaiians, Pacific Islanders
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266 pages
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