Noreen Mokuau

Participation of Minorities in Cancer Research

Overall, participation rates in cancer clinical trials are very low, ranging from 3 to 20% of eligible participants. However, participation rates are especially low among the socially disadvantaged and racial/ethnic minority groups that have been historically underrepresented in clinical research. Structural factors such as study duration, treatment or intervention schedule, cost, time, followup visits, and side effects represent more of a barrier to participation among these groups compared with white, non-Hispanics. Attitudes, beliefs, perceptions, and knowledge regarding clinical research, and cultural characteristics of underrepresented minorities pose additional barriers to participation. This article focuses on the structural, cultural, and linguistic factors that affect participation in clinical cancer research for each major U.S. racial/ethnic group. Low socioeconomic status, speaking a primary language other than English, differences in communication styles, mistrust of research and the medical system, fear, embarrassment, and lack of knowledge about the origin of cancer appear to have a negative impact on clinical cancer research participation rates. Much of the information about these factors comes from studies of cancer screening because little data is available on the factors that prevent and facilitate participation of minorities in clinical cancer trials specifically. Such research is needed, and, given the heterogeneity within and between minority populations, should occur in several different geographic settings and with as many different minority subpopulations as possible.

Mental health services for Asian Americans and pacific islanders

Inquiries over the past three decades have shown that ethnic minorities drop out of treatment early and tend to have poorer outcomes in psychotherapy. Despite the widespread acceptance that culturally responsive therapy and programs will produce better treatment outcomes for ethnic minorities, few studies have empirically tested this proposition. This paper reviews two types of interventions, ethnic match and parallel programs, to make the mental health system more responsive to the needs of Asian Americans and Pacific Islanders.

A Family-Centered Approach in Native Hawaiian Culture

One strategy for advancing culturally sensitive family practice is to identify family-centered approaches indigenous to the culture. The author describes a family-centered approach in native Hawaiian culture and encourages human service professionals to conceptualize family-centered models that utilize cultural values and processes.

Why Are Native Hawaiians Underrepresented in Hawai‘i's Older Adult Population? Exploring Social and Behavioral Factors of Longevity

Native Hawaiians comprise 24.3% of Hawai‘is population, but only 12.6% of the states older adults. Few published studies have compared health indicators across ethnicities for the states older adult population or focused on disparities of Native Hawaiian elders. The current study examines data from two state surveillance programs, with attention to cause of death and social-behavioral factors relevant to elders. Findings reveal that Native Hawaiians have the largest years of productive life lost and the lowest life expectancy, when compared to the states other major ethnic groups. Heart disease and cancer are leading causes of premature mortality. Native Hawaiian elders are more likely to report behavioral health risks such as smoking and obesity, live within/below 100–199% of the poverty level, and find cost a barrier to seeking care. Indicated is the need for affordable care across the lifespan and health services continuum. Future research might explain behavioral factors as influenced by social determinants, including historical trauma on Native Hawaiian longevity.

Assessing the Responsiveness of Health Services to Ethnic Minorities of Color

Ethnic minorities of color are disadvantaged on most indicators of health and wellness, yet, health services have not been adequately responsive to this groups needs. This paper explores the improvement of health services for this population by discussing common critieria for the assessment of responsiveness: availability, accessibility, and acceptability. Illustrative examples drawn from different ethnic minority groups will be utilized in the discussion of assessment criteria and ideas for cultural responsiveness highlighted.

Cultural Themes in Health, Illness, and Rehabilitation for Native Hawaiians: Observations of Rehabilitation Staff and Physicians

Increasing the cultural competency of health care providers requires an understanding of the cultural group being served. For Native Hawaiians, however, little is known about their participation in and views of rehabilitation. In this study, focus groups were conducted in which Native Hawaiian and non-Hawaiian rehabilitation professionals were asked to interpret utilization data and offer their perceptions of the rehabilitation experience of Native Hawaiians. Consistently noted were cultural values and traditions reflecting the importance of `aina (environment), `ohana (family), kuleana (specific responsibilities of family members), and kokua (mutual support and interdependence). Findings demonstrate the link between cultural values and health behaviors and provide guidelines that inform practice, policy, and research.

Culturally Based Solutions to Preserve the Health of Native Hawaiians

Health is that quality of life in which there is an absence of disease, and a presence of general well-being. For many Native Hawaiians, health encompasses a holistic perspective whereby all parts of the individual (biological, psychological, cognitive, social, spiritual) and world (individual, family, community, environment) are considered. Culturally based solutions for Native Hawaiians draw upon the strengths of the culture, with core elements including spirituality, and cultural values and practices, and the inclusion of Native Hawaiians in the design, implementation, and evaluation of interventions. The promotion of culturally based solutions does not imply the abandonment of all Western interventions of health care; rather, it suggests a need to expand our repertoire of knowledge on health and to learn from many sources. Examples such as Aloha ‘Āina (caring for the land) and ‘Ohana Intervention (working with families) illustrate new possibilities to complement Western interventions of health care. This article examines culturally based solutions to preserve the health of Native Hawaiians. Specifically, the discussion focuses on (1) cultural competence, (2) elements of culturally based solutions for Native Hawaiians, and (3) illustrations of culturally based solutions for Native Hawaiians.

Family support for native Hawaiian women with breast cancer

Background. A cancer diagnosis affects not only the individual but the entire family. Despite the growing body of literature on family support as a resource in cancer care, there is very little research on how cancer affects families in non-Western cultures. A minority population that experiences a disproportionate burden from cancer is Native Hawaiian women.Methods. In this study, 8 Native Hawaiian women with breast cancer and 17 family members of other Native Hawaiian women with breast cancer participated in focus groups examining family support. Specifically, types of support provided by the family (eg, informational, emotional, and tangible), changing dynamics of family roles, and recommendations for health care providers, with attention paid to the influence of culture on family support, were topics that were examined.Results. Similarly to other populations, Native Hawaiians viewed the family as the most important source of emotional and tangible support for women with cancer, and identified a need for increased informational support for both patients and families in the face of cancer. However, their reference to specific cultural values and practices within theohana (family) [eg,haku (family liaison) andho omana (spirituality)] reflects a uniqueness that has implications for clinical work with this population.Conclusions. Consideration of cultural values and practices may enhance health care services for this population.Background. A cancer diagnosis affects not only the individual but the entire family. Despite the growing body of literature on family support as a resource in cancer care, there is very little research on how cancer affects families in non-Western cultures. A minority population that experiences a disproportionate burden from cancer is Native Hawaiian women.Methods. In this study, 8 Native Hawaiian women with breast cancer and 17 family members of other Native Hawaiian women with breast cancer participated in focus groups examining family support. Specifically, types of support provided by the family (eg, informational, emotional, and tangible), changing dynamics of family roles, and recommendations for health care providers, with attention paid to the influence of culture on family support, were topics that were examined.Results. Similarly to other populations, Native Hawaiians viewed the family as the most important source of emotional and tangible support for women with cancer, and identified a need for increased informational support for both patients and families in the face of cancer. However, their reference to specific cultural values and practices within theohana (family) [eg,haku (family liaison) andho omana (spirituality)] reflects a uniqueness that has implications for clinical work with this population.Conclusions. Consideration of cultural values and practices may enhance health care services for this population.

Caregiving and Older Japanese Adults: Lessons Learned From the Periodical Literature

The United States is on the threshold of a substantial growth of older adults that increasingly reflects the cultural diversity inherent in this nation. Culture shapes the experience of aging and caregiving, and thus becomes an important factor when considering social services for older adults. One culturally distinct minority group—Japanese—is reputed to have one of the longest life expectancies in the US population, and, thus, information about their experiences may expand knowledge on aging and culture. A periodical literature review of older Japanese adults was undertaken to assess lessons learned about the association of aging and culture. Two important lessons that emerged emphasized the influence of cultural values on family caregiving, and women as caregivers. Implications for practice with this population are drawn and broad directions for the profession of social work are provided.

Preparing Students for Culturally Competent Practice Among Ethnic Minority Elders

The increase in the nations present and projected multicultural aged population is both dramatic and well documented. One result of this growth is a sharpened focus on racial and ethnic disparities in health, health care access, and utilization of services that impact aging adults. This paper presents work conducted by a university-community collaborative project in gerontology. The thrust of the project is that cultural competency is a key ingredient for preparing social work students for work with ethnic minority elders and for potentially improving services to older minority populations. A brief description of the project is presented with highlights of the standards of cultural competencies that were developed for three specific populations: Japanese, Filipino, and Native Hawaiians. In general, standards organized around knowledge, values and skills consistently reflect the importance of the family system in caring for older adults.