Academic journal article Journal of Cultural Diversity

Native Hawaiian Attitudes of Culturally Sensitive Healthcare Provider Traits and Behaviors

Academic journal article Journal of Cultural Diversity

Native Hawaiian Attitudes of Culturally Sensitive Healthcare Provider Traits and Behaviors

Article excerpt

Abstract: Provision of culturally competent healthcare has been an area of increasing focus in research due to increased mobility of individuals and increased ethnic and cultural diversity within the populations being served. A descriptive, exploratory design was used to investigate attitudes and perceptions of 61 Native Hawaiian adults regarding care provided to them and to identify areas for further study. Three major themes were identified: (1) Participants expected to be provided with family centered, holistic, respectful, and accepting health care; (2) Culturally competent care was described as direct, open, and honest communication expressed with concern; and (3) Uncaring behaviors were expressed as a lack concern or acceptance which appeared to negatively impact provider ability to form relationships with individuals and their families.

Key Words: Culturally Sensitive Healthcare, Native Hawaiian Attitudes, Traits and Behaviors

BACKGROUND

The timing of historical events, in addition to biological, psychological, and cultural issues, influences the health of both individuals and populations" (Browne, Mokuau, & Braun, 2009, p. 254). Prior to Western contact and colonization, Hawaiians had a thriving and sophisticated culture. In the late eighteenth century, the population of Native Hawaiians in Hawaii was at least 300,000 (Browne, Mokuau, & Braun) and rich "with a tradition of holistic health and well-developed practices for maintaining wellness and curing sickness" (Ka'opua, 2008, p. 171). Traditions of healing included spiritual, physical, and relational well-being. "The Hawaiian worldview emphasized collective affiliation and the interdependence of the individual, family, community, environment, and transcendent realms" (Browne, Mokuau, & Braun, p. 255).

One or the results of Western contact included a significant decline of the native population to 40,000 due to Western diseases to which they had no immunity. After an illegal overthrow of the Hawaiian monarchy by the United States military in 1893, American influences began to replace traditional practices of religion, education, politics, and economics (Browne & Mokuau, 2008). Culturally-based health solutions, as a rule, were thereafter "rarely offered or legitimized by government or health care organizations" (Browne, Mokuau, & Braun, 2009, p. 258). Even in light of the availability of western medical care, the Native Hawaiian population continued to decline. This marked collapse or the Native Hawaiian population may have contributed to a lack of trust and suspicion among Native Hawaiians for some aspects of Western health care.

Today, the increase in the nation's present and projected multicultural population is both dramatic and well documented. Over the last decade of the 19th century, Asian Americans, Native Hawaiians, and other Pacific Islanders (AAPI) had an astounding growth increase of 43% in population size nationwide (Browne & Mokuau, 2008). Currently, nearly 70% of the older adult populations in Hawaii are AAPI (Browne & Mokuau). As a result of increases in multiculturalism, there has been a sharpened focus on racial and ethnic disparities in health, health care access, and utilization of services as evidenced in the Healthy People 2010 campaign (Browne & Mokuau). In order to support progression of this national healthcare agenda it is paramount to understand these disparities before attempting to address them.

In general, Native Hawaiians have been identified as having higher rates of morbid conditions such as suicide and mental illnesses (Ida, 2007), cardiovascular diseases and related co-morbid conditions (Browne & Mokuau, 2008; Browne, Mokuau, & Braun, 2009), and communicable diseases such as Tuberculosis, Human Immunodeficiency Virus and Hepatitis B (Browne & Mokuau, 2008). In Hawaii, the proportion of Native Hawaiians and Pacific Islanders that experience the various morbid conditions mentioned above is greater than in those of other ethnicities living in Hawaii (State of Hawaii DOH, 2008). …

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