Kalihi Palama Health Center

Partnerships between communities and academic institutions have been vital in addressing complex health and psychosocial issues faced by culturally diverse and hard-to-reach populations. Community-based participatory research (CBPR) has been suggested as a strategy to develop trust and build on the strengths of partners from various settings to address significant health issues, particularly those persistent health issues that reveal disparities among minority populations. There have been many challenges to developing these partnerships in the United States. The purpose of this paper is to discuss approaches and solutions used by this research team in response to the challenges they have faced in using CBPR. The team uses CBPR to understand and support the process of disclosure of intimate partner violence (IPV) within the context of the community health centers that provide services for multicultural and multi-lingual populations. While CBPR provides a route to develop trust and build on the strengths of partners from various settings, there are multiple challenges that arise when partnering organizations present with different infrastructures, missions, resources and populations served. Examples of common challenges and solutions from the literature and from the team's experience will be discussed. Implications for partners, partnerships, practice and research will be explored.

PURPOSE: The goals of this study were (a) to gather data regarding the documentation of disclosure of battering in primary care settings and (b) to collect demographic data, including ethnicity, of women who disclose intimate partner violence (IPV) in primary care settings in Hawaii. DATA SOURCES: We conducted a retrospective chart review focusing on documentation of IPV in four community health centers on Oahu. The review included 337 charts. The data were analyzed using descriptive statistics. CONCLUSIONS: Of the 337 records reviewed, IPV was reported in 31 (9.1%). Documentation of reported IPV differed among members of the various ethnic groups seen in the clinics. IMPLICATIONS FOR PRACTICE: Practitioners should develop a common area for documenting reports of IPV. The level and depth of resources available within the setting and the community may affect providers' willingness to screen for IPV.

OBJECTIVE: The objective of this study was to determine whether anterior colporrhaphy plus insertion of anterior dermal allograft reduces anterior prolapse recurrence at 1 and 7 to 10 years postoperatively compared with anterior colporrhaphy alone. METHODS: We present a nonblinded randomized controlled trial with 1- and 7- to 10-year follow-up. Subjects were randomized between 2005 and 2008 to anterior colporrhaphy or ultralateral anterior colporrhaphy plus insertion of a dermal allograft spanning the anterior compartment between the arcus tendineus fascia pelvis on each side. Eligible subjects had anterior prolapse to the hymen or beyond, were bothered by their prolapse, and were planning to undergo surgical correction. Subjects completed a pelvic organ prolapse quantification system (POPQ) examination and Pelvic Floor Distress Inventory (PFDI)/PFDI-20 before surgery; a POPQ, PFDI, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire at 1 year postoperatively; and a POPQ, PFDI-20, Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, Revised, and Patient-reported Global Impression of Improvement Inventory at 7 to 10 years postoperatively. Our primary outcome was anatomic anterior prolapse recurrence at 1 or 7 to 10 years defined as Aa or Ba greater than or equal to -1. Our secondary outcome was a composite score of anterior prolapse recurrence at 1 or 7 to 10 years defined as anatomic recurrence (Aa or Ba ≥ 0), retreatment for cystocele, or answering yes to PFDI-20 question 3 (subjective report of vaginal bulge). RESULTS: A total of 114 subjects were randomized, 70 to anterior colporrhaphy and 44 to anterior colporrhaphy plus dermal allograft. About 92% of subjects underwent concomitant apical suspension, 98% in the graft group and 89% in the nongraft group. Eighty-nine subjects (32 graft [73%], 57 nongraft [81%]) returned for 1-year follow-up. Fifty-three patients (19 graft [48%], 34 nongraft [49%]) returned for 7- to 10-year follow-up. The primary outcome was met by 8 (18%) graft and 22 (31%) nongraft subjects at 1 year postoperatively (P = 0.26) and by 10 (23%) graft and 24 (34%) nongraft subjects at 7 to 10 years postoperatively (P = 0.37). The secondary outcome was met by 8 (18%) graft and 15 (21%) nongraft subjects at 1 year postoperatively (P = 0.74) and by 13 (30%) graft and 21 (30.0%) nongraft subjects at 7 to 10 years postoperatively (P = 0.99). CONCLUSIONS: We cannot conclude whether there is a difference in anterior recurrence for anterior colporrhaphy with and without dermal allograft and do not recommend changes in clinical practice based on these results.

Although many cancer survivors address cancer-related concerns through contact with fellow patients in support groups, few reports have focused on the experience of Asians and Pacific Islanders. This report summarizes the results of semistructured interviews with 24 participants in a well-established prostate cancer support group in Hilo, Hawaii, 17 of whom were of Asian or Pacific Islander ancestry. According to the men, the benefits of group participation include camaraderie, information, improved coping ability, and ability to discuss medical experiences. The group's success was attributed to its peer leadership, participation of peer-professionals, and members' widespread participation in a variety of activities. The group contributed to the larger community by organizing specific events for family members, interacting outside the meetings, and tailoring group activities to reflect multicultural preferences for communication. The experiences of the Hilo group contrast with the experiences of other support groups reported in the literature. Although information seeking in the group was important, emotional and social support was at least as significant, and use of humor and discussions of negative experiences regarding medical care were common. The group's distinctive features may stem from the values and norms of its close-knit, multiethnic, predominantly Asian and Pacific Islander small-town community. The findings imply that for prostate cancer support groups, one “size” does not fit all men and communities and that tailoring support groups to the intended participants is crucially important.

PURPOSE: To explore young, multi-ethnic adolescents' attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led, tobacco prevention drama. DESIGN: Focus groups and demographic surveys. SETTING: Island of Oahu, Hawaii. PARTICIPANTS: Fifty-four multi-ethnic youth, ranging in age from 10 to 14 years, participated. The study was promoted in schools with a large representation of Hawaiian, Filipino, and Pacific Islander students. METHODS: Each of five focus groups was audio-recorded, and an observer recorded extensive notes throughout the sessions. Content analysis consisted of coding focus group notes for recurrent themes and using the audio recording as confirmation. RESULTS: Just more than one quarter (n = 15) of the youth had tried smoking, and two-thirds (n = 35) currently lived with someone who smoked. Participants expressed the feeling of being surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members' tobacco use, and they desired skills that could enable them to help family members stop using tobacco. CONCLUSION: Family influences may play an important role in youth attitudes toward tobacco use, especially given the cultural significance of extended family and of filial piety that are reflected in many traditional, Asian and Pacific Islander families. Interventions targeting youth in Asian and Pacific Islander communities should incorporate key cultural references to the extended family and to a respect for elders to establish relevance in the life experiences of young people in these population groups.

The use of drama as a preventive education measure has demonstrated success in various health promotion venues and offers promise in promoting positive youth attitudes and behavior change related to tobacco use. Especially important is a need to implement culturally relevant methods to reach youth. This article describes the development and implementation of a tobacco prevention drama for Asian and Pacific Islander youth. The resulting play, Crossroads, features a soap opera-style drama interspersed with humorous vignettes and multimedia effects and incorporates cultural cues, mannerisms, dress, and values consistent with Asian and Pacific Islander youth culture. Evaluation data indicate that the drama has an effect on audience knowledge, attitudes, and intended behavior, including a change in future intent to smoke cigarettes and the ability of audience members to develop connections with the characters in the play and apply concepts that are presented in the play to their own lives.

Increasingly more people are spending their final days of life in nursing homes. Unfortunately, research suggests that end-of-life care in nursing homes is frequently suboptimal and pain is not well managed. As much of the care in nursing homes is provided by unlicensed staff, particularly certified nursing assistants, who have limited preemployment education, it is vital to provide them with appropriate in-service training related to dying, death, and bereavement. This article describes the development and testing of an 8-hour curriculum for paraprofessional staff in nursing homes that features active-learning strategies. Participants demonstrated high scores on posttests of training content, and they significantly improved their scores on personal comfort with providing end-of-life care over the course of training. Staff turnover, time constraints, and lack of institutional commitment for training were major barriers to broader participation. The use of this active-learning in-service curriculum represents an effective way to provide end-of-life care training to paraprofessional nursing home staff.

Asian American and Pacific Islander (AAPI) women have low breast and cervical cancer (BCC) screening rates compared to other ethnic groups. However, there is a lack of culturally tailored programs designed to promote screening practices within AAPI communities. The CARE Program sought to reduce BCC morbidity and mortality rates among AAPI women by building the capacity of community health centers to deliver effective, culturally and linguistically appropriate screening programs in six different AAPI communities. This paper will (1) provide an overview of the CARE Program, (2) highlight a BCC screening program for a Filipino community in Hawaii, (3) present specific cultural tailoring strategies from the program, and (4) discuss program challenges and propose recommendations for future breast and cervical cancer interventions with Filipino communities in Hawaii.

The relationship between the eye movement pattern during stair descent and illumination was studied in 4 elderly people in comparison with that in 5 young people. The illumination condition was light (85.0±30.9 lx) or dark (0.7±0.3 lx), and data of eye movements were obtained using an eye mark recorder. A flight of 15 steps was used for the experiment, and data on 3 steps in the middle, on which the descent movements were stabilized, were analyzed. The elderly subjects pointed their eyes mostly directly in front in the facial direction regardless of the illumination condition, but the young subjects tended to look down under the light condition. The young subjects are considered to have confirmed the safety of the front by peripheral vision, checked the stepping surface by central vision, and still maintained the upright position without leaning forward during stair descent. The elderly subjects, in contrast, always looked at the visual target by central vision even under the light condition and leaned forward. The range of eye movements was larger vertically than horizontally in both groups, and a characteristic eye movement pattern of repeating a vertical shuttle movement synchronous with descent of each step was observed. Under the dark condition, the young subjects widened the range of vertical eye movements and reduced duration of fixation. The elderly subjects showed no change in the range of eye movements but increased duration of fixation during stair descent. These differences in the eye movements are considered to be compensatory reactions to narrowing of the vertical visual field, reduced dark adaptation, and reduced dynamic visual acuity due to aging. These characteristics of eye movements of the elderly lead to an anteriorly leaned posture and lack of attention to the front during stair descent.

OBJECTIVES: The objectives were to report how to promote tuberculosis (TB) control including DOTS (Directly Observed Treatment, Short-course) programs, and to evaluate the results of TB control programs in Shinjuku Ward (Shinjuku-ku). SETTING AND CHARACTERISTICS: Inhabitants and TB patients in Shinjuku Ward. Shinjuku Ward is located in the center of metropolitan Tokyo and has typical urban TB problems, such as high incidence rate and TB among foreigners and the homeless. The TB incidence rates in Shinjuku Ward decreased from 83.9 per 100,000 population in 1999 to 42.5 per 100,000 population in 2006, however, the rates were still two times higher than the national average. Therefore, one of the important TB programs in Shinjuku has been to actively detect cases among high-risk groups such as foreigners and the homeless. METHODS: We observed the trend of case detection rates by health examination with chest X-ray among different high-risk groups, and compared the treatment outcomes before and after DOTS program execution. We also reviewed the changes of re-treatment rates and drug resistance rates. RESULTS: The case detection rates of TB by health examinations of foreign students at Japanese language schools decreased from 0.49% in 1996 to 0.13% in 2006 (p = 0.021). Although the case detection rates decreased, they were still about 26 times higher than those of Japanese students. While, the case detection rates among the homeless remained high with 4.7%, 3.3%, 4.5% and 3.6% in 1999-2002, respectively, since 2003, however, they had decreased and no TB cases were detected in 2005-2006. The DOTS program for homeless TB patients has been carried out since 2000 and that for the foreigners since 2003. The rates of defaulting during treatment before DOTS were very high among both homeless patients (21.4%) and foreigners (29.8%) in 1998-1999. However, after the introduction of DOTS program, those rates declined to 10.4% (p = 0.014) among the homeless and 7.8% (p = 0.002) among foreigners in 2002-2004. The proportion of newly notified patients with previous TB treatment and those with multi-drug resistant TB (MDR-TB) have also decreased after the introduction of DOTS programs. From 2000-2002 to 2003-2006, the re-treatment rates decreased from 19.4% to 10.0% (p < 0.001) and MDR-TB rates decreased from 1.6% to 0.2% (p = 0.042), respectively. DISCUSSION: The key points of TB control in Shinjuku Ward are to detect TB cases early especially among the high-risk groups, and to assist all TB patients to complete their treatment. In order to expand this strategy, besides promoting active case findings among high-risk groups, we have developed many types of DOTS programs, considering each patient's lifestyle and cooperating with school teachers at schools, pharmacists at pharmacies, home-care specialists at homes or facilities for the elderly, and so on. Among others, a major premise for the homeless and some other socially disadvantaged patients was to guarantee the provision of medicine and living by introducing social welfare services, before starting DOTS programs. This approach might have helped to reduce the defaulting rate, relapse rate and MDR-TB rate.

Since 1992, 120 medical, nursing, social work and public health students have participated in an interdisciplinary community service-learning seminar held on-site at a community health center in Hawai'i. During this time, the community health center staff who teach this course have developed and adapted a range of didactic and experiential methods for building cultural competence. The community faculty selects a diverse, multiethnic team of health professions students who form a "learning laboratory" as they plan and implement health education at a neighborhood elementary school serving an Asian and Pacifican community. We report here on a qualitative evaluation of a model for teaching cross-cultural competence that utilizes structured experiential lessons, service-learning in a community setting, and interdisciplinary training.

PURPOSE: This study sought an improved understanding of household emergency preparedness (EP) among Native Hawaiian, Pacific Islander, and Filipino (Indigenous Pacific People [IPP]) parents in Hawaii. DESIGN: We conducted an exploratory qualitative descriptive study with 60-minute interviews occurring from October 2022 through March 2023. A semi-structured interview guide exploring participant household EP was employed. METHODS: Prospective participants were females who identified as IPP, caregivers of a 0-12-year-old child, spoke English, and received health services at a federally qualified health center clinic. Two researchers conducted qualitative content analysis on interview transcripts. Initial coding of transcripts identified broad categories or themes. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified final themes and subthemes. FINDINGS: Participants (N=25) were female, between 30-49 years of age (68%), had received some college education (60%), and were fully employed (68%). Major themes included: 1) Perceptions of family EP and current behaviors, 2) Barriers and challenges to family EP, and 3) Perspectives on strategies to improve family EP. Subthemes included risk perception for emergencies; family EP practices; health protection and pandemic preparedness; lack of knowledge and experience; social, cultural and economic barriers; and clinic-based, technology-driven, and community-based interventions. CONCLUSION: Factors impeding access to healthcare services also impede family EP among IPP groups and their ability to mitigate the impact of future public health emergencies. CLINICAL EVIDENCE: Targeted, innovative interventions, including ones led by health clinics and those that utilize technology, are needed to overcome common barriers faced and to facilitate the uptake of household EP behaviors among IPP families.

Pediatric care providers are often discouraged by the scope and magnitude of our current childhood overweight epidemic. Numerous studies have shown the adverse consequences of pediatric obesity, ranging from short-term physical and psychosocial consequences to long-term consequences that manifest in adulthood. In this study we investigated rates of overweight and at-risk for overweight children in a community health center in urban Honolulu, Hawai'i which serves a large multi-cultural and multi-ethnic population with a large presence of Asians and Pacific Islanders. This was done by conducting a chart review of the pediatric patients in the clinic. Twenty-four children had been formally diagnosed and recorded in their charts as obese/overweight during the last 2 years, out of 4,640 pediatric patients seen (less than 0.5%). However, according to this study roughly 140 overweight children are seen monthly at this clinic, indicating a prevalence of more than 50%. Samoan and Micronesian children were found to be primarily impacted.

The aims of this project were to minimize organizational barriers and increase access to immunizations for children aged 6 months to 21 years in a multiethnic community health center in Honolulu. The intervention consisted of opening a "walk-in" shot clinic (WISC), run by a nurse practitioner, 2 evenings per week and Saturdays. Between January and July 2005, 351 clients accessed the clinic, with 774 immunizations administered. Clinic satisfaction measures were excellent. Up-to-date immunization status for all clients improved significantly. The WISC is an effective and customer-friendly way to improve childhood and adolescent immunization rates in a community health center setting.

Non pharmacological treatments for mild hypertension have been paid attention recently. We examined the effectiveness of mild exercise training for hypertensives and aimed the development of health-optimising program 'health formula'. Twenty three volunteers with either high systolic pressures over 140mmHg or high diastolic pressures over 90mmHg and without other diseases joined 'Exercise Class for Mild Hypertensives'. Twice a week, every Monday and Friday, from September 20, 1985 to December 20, 1985, they took 90-minite class. They had trainings of walking, jogging and other exercises with 50% of maximal intensity. After 3 month training, subjects showed improvement in swiftness, flexibility and balance. Blood pressures decreased 14mmHg in systolic and 7mmHg in diastolic (p&lt;0.05, respectively). Electrocardiogram showed improvement of myocardial ischemia in all 3 subjects who had had impairment before training. Blood sugar, triglycerides, β-lipoproteins and total lipids decreased significantly in subjects compared with age-matched control group (n=10). Renal function (serum creatinine) improved. In psychological approaches, subjects showed good effects such as improved stability of emotion. (Journal of Health Science, Kyushu University 9: 63-78, 1987)

Introduction Psychotic disorders typically have their onset in adolescence, a formative age that comes with many developmental challenges. The onset of mental illness in this phase of life can be very disruptive. Literacy on the nature and potential impact of psychosis can promote recovery, while family interventions have the potential to prevent relapse. Moreover, many patients and family members report a need for tools that provide guidelines to improve their communication and stimulate mutual understanding. However, an integrated psyche-education module for both adolescents with lived experience and their relatives was lacking until now. Objectives The development of a new integrated psycho-education module and the content of this module will be presented, Methods Stakeholders (people with lived experience and family members) were interviewed on their preferences for the content, form and timing of psycho-education individually (n=15) and in focus groups (n=7). This information was used by a task force of experts composed of people with lived experience with psychosis, family members and mental health professionals. Subsequently, the intervention was piloted in two mental health care organizations. Results Adolescents with lived experience preferred psycho-education on communications skills and wanted to learn how to communicate with their relatives during and after the psychotic episode, adjusted to their specific situation. They prefer psycho-education together with their relatives, not separately. They also noted that the content of psycho-education may differ depending on the relationship they have with their relatives. Relatives and people with lived experience both reported they needed basic knowledge about psychosis, training in communication and problem solving skills, content with respect to self-care and content about online information. With regards to the timing of psycho-education, relatives preferred basic information as soon as possible and communication skills later on. Both groups felt an integrated psycho-education could be beneficial. The final integrated module is composed of themes related to different dimensions of recovery, e.g. societal and social impact and spirituality. Results of the pilot were used to refine the module. Conclusions This new integrated psycho-education module was based on stakeholders preferences and needs and was found to be helpful to increase mental health literacy and communication between adolescents with lived experience with psychosis and their relatives. Disclosure of Interest None Declared