Age-Friendly Health Systems and cultural relevancy: Exploring the application of the geriatrics 4Ms model with Native Hawaiian elders

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dc.contributor.advisorBraun, Kathryn L.
dc.contributor.authorIbrao, Miquela
dc.contributor.departmentPublic Health
dc.date.accessioned2024-02-26T20:14:10Z
dc.date.available2024-02-26T20:14:10Z
dc.date.issued2023
dc.description.degreeDr.P.H.
dc.identifier.urihttps://hdl.handle.net/10125/107920
dc.subjectPublic health
dc.subjectIndigenous studies
dc.subjectGerontology
dc.subject4Ms framework
dc.subjectgeriatric health
dc.subjectkūpuna
dc.subjectNative Hawaiian
dc.titleAge-Friendly Health Systems and cultural relevancy: Exploring the application of the geriatrics 4Ms model with Native Hawaiian elders
dc.typeThesis
dcterms.abstractThe US Health Resources and Services Administration has made educating providers, families, and caregivers on the 4Ms framework a requirement of federally funded programs like the Geriatrics Workforce Enhancement Program (GWEPs). The 4Ms – Mobility, What Matters, Medication, and Mentation –were originally developed as a medical framework intended for use with healthcare practitioners. The prioritization of the framework by the Health Resources and Services Administration has resulted in its adaptation for use with patients, families, and caregivers. As GWEPs works to move the 4Ms model from hospital-based care to community care, it is important that the model be translated from clinical use to a model that can be used effectively with communities. The purpose of this dissertation was to assess 3 of the 4Ms of geriatrics – Mobility, What Matters, and Medications – to support Native Hawaiian kūpuna aging preferences. Study 1 explored differences in mobility limitation between race/ethnic groups of community dwelling older adults age 55+ in Hawai‘i using the Hawai‘i Behavioral Risk Factor Surveillance System (BRFSS). Analyses found that Native Hawaiians have a higher prevalence ratio and odds ratio of mobility limitations at younger ages when compared to other race/ethnicities included in the study. SDOH independent variables suggested that social interventions may be effective in promoting mobility with the population. Study 2 explored What Matters in healthcare through a qualitative analysis of 20 Native Hawaiian kūpuna interviews. Themes identified included the routine incorporation of traditional healing, a strong sense of family as part of their decision-making processes, varied preference for home-based care at the end-of-life, and the importance of healthcare practitioners taking the time to “talk story” and building relationships with the communities they serve. Study 3 conducted a systematic review on existing programs that integrate Traditional Medicine into Western healthcare settings and their effectiveness with Indigenous populations in the US. A majority of the models described with American Indian and Alaskan Native populations were on the topic of behavioral health, particularly substance abuse and mental health, while with Native Hawaiians they were on general health with primary care clinics. Findings on effectiveness showed positive impacts on experience of care and population health suggesting the model holds promise. Three conclusions from overall findings of the study were: Native Hawaiian kūpuna need mobility intervention at younger ages than the retirement age of 65; What Matters in health for kūpuna vary and it is important that providers “talk story”; and Traditional Medicine is a valued and effective model of care. Although the 4Ms are packaged as distinct entities they often overlap, resulting in findings from multiple studies supporting recommendations for Mobility, What Matters and Medication. A recommended 5th M – multicultural – could promote culturally relevant care in Western healthcare systems.
dcterms.extent107 pages
dcterms.languageen
dcterms.publisherUniversity of Hawai'i at Manoa
dcterms.rightsAll UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
dcterms.typeText
local.identifier.alturihttp://dissertations.umi.com/hawii:11934

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