A Qualitative Study to Understand the Opportunities and Challenges of Integrating ʻŌlelo Hawaiʻi (Native Hawaiian Language) into Medical Education in Hawaiʻi

Abstract

INTRODUCTION: In 1978, ʻŌlelo Hawaiʻi (OH) became one of the official languages of the State of Hawaiʻi, the ancestral home of Native Hawaiians (NHs). Since 1986, Hawaiian language immersion and fluency have grown and OH is now frequently spoken among NHs and non-NHs throughout the State. With the growing demand for OH fluency, medical education and health care services are experiencing an expressed need for “language-concordant care”. Language-concordant care (LCC) occurs when patients and providers communicate in a shared language, and it has been shown to improve trust and health outcomes and reduce medical errors and adverse events. LCC studies investigating the incorporation of Spanish, Arabic, and te reo Māori into medical education have shown increased comfort and rapport with patients. They also demonstrate that physicians who have undergone LCC training are more likely to take care of a patient who prefers to speak that language in the future. This emphasizes the need to prioritize the integration of language into medical education rather than relying on interpretation services. These are among a limited number of studies evaluating the potential impact of teaching indigenous language fluency (i.e. OH) to medical students as a means to improve patient-provider relationships, health outcomes, behaviors, and/or health literacy. Yet, Indigenous peoples, such as NHs, are known to experience persistent health disparities that could be improved with stronger communication skills, patient-provider interactions, and the building of trust.

OBJECTIVE: To better understand the opportunities and challenges of teaching conversational ʻŌlelo Hawaiʻi (OH) in medical school curricula in Hawaiʻi.

METHODS: IRB approval was obtained. Participants (n=19) engaged in semi-structured focus groups (n=4) or a key informant interview (n=1). These included 11 medical students (median age=27 years), 3 OH language instructors (median age=51 years), and 6 medical education faculty (median age=60 years). Thirteen participants (68.4%) were women and 13 (68.4%) identified as Native Hawaiian. All 19 participants reported that their first language was English. The most selected language spoken at home was English (64.3%), followed by Hawaiian (17.9%), Pidgin (7.1%), French (3.6%), Tahitian (3.6%), and Japanese (3.6%). Two researchers employed thematic content analytic methods and used both inductive and deductive coding to independently code all 5 transcripts.

RESULTS: Five major themes emerged: (1) Language and the Native Hawaiian cultural context; (2) Use of ‘Ōlelo Hawaiʻi in the community; (3) Clinical benefits of speaking ‘Ōlelo Hawaiʻi; (4) Structure of integrating ‘Ōlelo Hawaiʻi - logistics, barriers, and opportunities; and (5) Medical education curricula enhanced by ‘Ōlelo Hawaiʻi - teachers, content, and design. Overall, themes 1-3 suggested that ʻŌlelo Hawaiʻi would provide NH cultural context, meet community support, and provide clinical benefits. Themes 4 and 5 addressed practical issues such as time constraints and development of curricula.

DISCUSSION: Initial perspectives from teachers (medical education and ʻŌlelo Hawaiʻi) and learners of medical education were overwhelmingly positive on incorporating ʻŌlelo Hawaiʻi into medical education and eventually into health care services. Future studies are needed to further refine the process of development and implementation and to investigate expected outcomes such as quality of care, trust, and reducing health inequities.

TARGET AUDIENCE: Medical students and medical education faculty.