Listening to the Voices of Native Hawaiian Elders and ‘Ohana Caregivers: Discussions on Aging, Health, and Care Preferences

Abstract

Native Hawaiians, the indigenous people of Hawai’i, are affected by varying social and health disparities that result in high prevalence of chronic disease, early onset of disability, and shorter life expectancy compared to other ethnic groups in Hawai’i. Six listening meetings were conducted, involving 41 community-dwelling kūpuna (Native Hawaiian elders) and ‘ohana (family) caregivers to investigate health and care preferences that offer the potential for improving well-being in later life for Native Hawaiian elders. As background, we provide three explanatory perspectives and theories—life course perspective, minority stress theory, and historical trauma—that guided the design of this study and provided the study’s context. A number of overarching themes and subthemes were identified, some of which point to universal concerns with age and caregiving (such as challenges and costs associated with growing old and caregiving) and others that are culturally specific (such as influence of culture and social stressors, including discrimination, on health needs and care preferences). Results give further support to the urgency of affordable, accessible, and acceptable programs and policies that can respond to the growing health and care needs of native elders and family caregivers.

Trust and world view in shared decision making with indigenous patients: A realist synthesis

“… Effective communication is enabled when the beliefs, values, and language of the indigenous person are incorporated into the interaction . Health‐care providers without effective communication skills may erode the patient's perception of cultural respect and pride . Health‐care providers must work to reduce power imbalances in order to build reciprocal respect reduce patient anxiety and increase trust .…”

“…An essential form of culturally appropriate knowledge translation is storytelling. Storytelling passes information through personalized communication and has been used for generations . It is a means of transmitting information, including health information that incorporates cultural and spiritual values.…”

“…63 Health-care providers without effective communication skills may erode the patient's perception of cultural respect and pride. 58,71 Health-care providers must work to reduce power imbalances in order to build reciprocal respect reduce patient anxiety and increase trust. 4 When an individual perceives there is a more balanced relationship with the HCP, trust increases and anxiety decreases, 41 making SDM engagement more likely.…”

Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states

“…This is important to address because of the cultural value of filial piety and the expectation of caring for their loved ones at home rather than in a nursing home (Browne, Braun, Mokuau, Ka'opua, & Higuchi, 2011). Cultural expectations and obligations related to caregiving vary by race and gender (Dilworth-Anderson et al, 2005).…”

American Indian and Alaska Native resilience along the life course and across generations: A literature review

“…The life course theory, attributed to sociologist Elder (1998), is used as a framework in gerontology, social work, and maternal child health research (Braveman & Barclay, 2009; Browne et al, 2014). Central to the life course framework is consideration of the social, cultural, economic, and political factors that impact human development and health (Elder, 1998; Fine & Kotelchuck, 2010).…”