Chuukese community experiences of racial discrimination and other barriers to healthcare: Perspectives from community members and providers
Keywords:social determinant of health, racial discrimination, social justice, health equity, healthcare, Pacific Islander, Micronesian, Hawaii
AbstractRacial discrimination is a critical barrier to quality healthcare for many ethnic/racial groups in the United States (US). Chuukese are a rapidly growing, yet understudied, Pacific Islander group in the US. Research suggests that Pacific Islanders in the US have a high burden of chronic and infectious diseases, but underutilize preventive health services. The purpose of this study was to explore the Chuukese community’s experiences with healthcare, particularly reports of racial discrimination. In-depth interviews were conducted with nine Chuukese community participants and eight healthcare providers serving this community in Hawai‘i. Purposive and referral sampling were used to identify participants. Data were analyzed using framework analysis. Barriers to healthcare utilization included inadequate healthcare coverage and lack of trust between providers and patients due to differences in language and culture. All participants shared examples of racial discrimination experienced by Chuukese individuals both in and out of the healthcare system. Many participants revealed that racial discrimination was often difficult to discuss openly, and that it negatively impacted their health by increasing stress and mistrust and decreasing access to needed services. Participants recommended concrete actions to broach conversations regarding racial discrimination, including creating a neutral agency to address complaints and asking about patients' family and community experience with discrimination. Providers shared how they modified their care to better serve Chuukese patients by recognizing and building on community assets, such as strong religious and family connections. These findings are relevant to providers working to address racial discrimination and improving healthcare for underrepresented immigrant ethnic groups.
Marmot, M. Achieving Health Equity: From Root Causes to Fair Outcomes. The Lancet. 2007 370(9593):1153-63.
Weech-Maldonado R, Hall A, Bryant T, et al. The Relationship Between Perceived Discrimination and Patient Experiences with Healthcare. Medical care. 2012 50(902):S62.
Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. Journal of behavioral medicine. 2009 Feb 1;32(1):20-47.
Paradies Y, Priest N, Ben J. Racism as a determinant of health: A protocol for conducting a systematic review and meta-analysis. Systematic Reviews 2013 2(85).
Gonzales KL, Harding AK, Lambert WE, et al. Perceived Experiences of Discrimination in Healthcare: A Barrier for Cancer Screening Among American Indian Women with Type 2 Diabetes. Women's Health Issues. 2013 23(1):e61-7.
Sorkin DH, Ngo-Metzger Q, De Alba I. Racial/ethnic Discrimination in Healthcare: Impact on Perceived Quality of Care. Journal of General Internal Medicine. 2010 25(5):390-6.
Paradies, Y. A Systematic Review of Empirical Research on Self-reported Racism and Health. International Journal of Epidemiology. 2006 35(4):888-901.
Williams DR, Neighbors HW, Jackson JS. Racial/ethnic Discrimination and Health: Findings from Community Studies. American Journal of Public Health. 2003 93(2):200-8.
Look MA, Trask-Batti MK, Agres R, et al. Assessment and priorities for health & well-being in Native Hawaiians & other Pacific peoples. Center for Native and Pacific Health Disparities Research. Honolulu HI: University of Hawai’i. 2013.
Riklon S, Alik W, Hixon A, et al. The ‘Compact Impact; in Hawai‘i: Focus on Healthcare. Hawai‘i Medical Journal. 2010 7:7-11.
Palafox NA, Riklon S, Esah S, et al. 2012. “The Micronesians.” In People and Cultures of Hawai‘i ; the Evolution of Culture and Ethnicity, edited by McDermott JF, Naupaka N; Honolulu: University of Hawai‘i Press.
Shek D, Yamada S. Health care for Micronesians and constitutional rights. Hawaii Medical Journal. 2011 Nov;70(11 Suppl 2):4.
MacNaughton NS, Jones ML. Health Concerns of Micronesian Peoples. Journal of Transcultural Nursing. 2013 1043659613481675.
Hagiwara MK, Miyamura J, Yamada S, et al. Younger and Sicker: Comparing Micronesians to Other Ethnicities in Hawaii. American journal of public health. 2016 Feb(0):e1-7
Blair C. No aloha for micronesians in Hawaii. Honolulu Civil Beat.[Internet] 2011 June 20 [cited 2016 March 10] Avaliable from: http://www.civilbeat.com/articles/2011/06/20/11650-no-aloha-for-micronesians-in-Hawaii
Yamada S. Discrimination in Hawai‘i and the health of Micronesians and Marshallese. Hawaii J Public Health. 2011 3(1):55-7.
Saunders A, Schiff T, Rieth K, et al. Health as a Human Right: Who is Eligible. Hawaii Med J. 2010 Jun; 69:4-6.
Bastos JL, Celeste RK, Faerstein E, et al. Racial discrimination and health: a systematic review of scales with a focus on their psychometric properties. Social science & medicine. 2010 Apr 30;70(7):1091-9.
Podsiadlowski A, Fox S. Collectivist Value Orientations Among Four Ethnic Groups: Collectivism in the New Zealand Context. New Zealand Journal of Psychology. 2011 40(1):5-18.
Maxwell JA. Qualitative Research Design: An Interactive Approach. Thousand Oaks, CA: Sage Publications, Inc. 2013
Patton, MQ. Qualitative evaluation and research methods (3nd ed.). Thousand Oaks, CA: Sage Publications. 2002
Perez DF, Nie JX, Ardern CI, et al. Impact of Participant Incentives and Direct and Snowball Sampling on Survey Response Rate in an Ethnically Diverse Community: Results from a Pilot Study of Physical Activity and the Built Environment. Journal of Immigrant and Minority Health. 2013 15(1):207-14.
Choi JY. Seeking Healthcare: Marshallese Migrants in Hawai‘i. Ethnicity and Health. 2008 13(1):73-92.
Pobutsky AM, Krupitsky D, Yamada S. Micronesian Migrant Health Issues in Hawai‘i: Part 2: An assessment of Health, Language and Key Social Determinants of Health. Californian Journal of Health Promotion. 2009 7(2):32-55.
Mellor D. Responses to Racism: A Taxonomy of Coping Styles Used by Aboriginal Australians. American Journal of Orthopsychiatry. 2004 74(1):56.
MicSem Monthly Discussion Topic. Women's Role in Micronesia: Then and Now #6 March 8, 1994. http://www.micsem.org/pubs/conferences/frames/womtradfr.htm
Gale NK, Heath G, Cameron E, et al. Using the Framework Method for the Analysis of Qualitative Data in Multi-disciplinary Health Research. BMC medical Research Methodology. 2013 13(1):117.
Gee GC, Ro A, Shariff-Marco S, Chae D. Racial Discrimination and Health Among Asian Americans: Evidence, Assessment, and Directions for Future Research. Epidemiologic reviews. 2009 31(1):130-51.
Chin MH, Marshall H., Nocon R., et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Internal Med. 2010 27(8):922-1000. DOI: 10.1007/s11606-012-2082-9.
Aitaoto N, Braun KL, Estrella J, et al. Design and results of a culturally tailored cancer outreach project by and for Micronesian women. Prev Chronic Dis. 2012 9:100262.