The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated ... more The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated Pacific Islands (USAPI) to implement the Regional Comprehensive Control Plan: 2007-2012, and to evaluate its coalition and partnerships. The Pacific Center of Excellence in the Elimination of Disparities (CEED), aims to reduce cancer disparities and conducts evaluation activities relevant to cancer prevention and control in the USAPI. The PRCC Self (internal) and Partner (external) Assessments were conducted to assess coalition functioning, regional and national partnerships, sustainability, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific. Self-administered questionnaires and key informant telephone interviews with PRCC members (N=20), and representatives from regional and national partner organizations were administered (N=26). Validated multi item measures using 5-point scales on coalition and partnership characteristics were used. ...
The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce de... more The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was...
Journal of Nepal Health Research Council, Jun 2, 2022
Background: Mid-level health workers are deployed in a large proportion with the expectation of s... more Background: Mid-level health workers are deployed in a large proportion with the expectation of similar patient outcomes as with physicians. Mid-level practitioners are Health Assistants and Auxiliary Health Workers who provide clinical care at remote locations. National Health Training Center has been providing 60 days in-service Mid-level Practicum training since 2009 AD for the mid-level practitioners with the aim to enhance quality of patient care in Nepal. Methods: An observational study conducted using retrospective data from onsite follow-up assessment of 180 Mid-level Practitioner from 18 districts of Nepal between July 2015 to June 2019. The retention of competency onsite follow-up was calculated as percentage of assessment score at the end of Mid-level Practicum training. Percentage retention of competency and association of retention with factors were analyzed using independent t-test. Results: Majority of participants were male (85.6%), and working in a Health Post (84.4%). Average clinical competency retention in each domain at their work place was 68.79% in knowledge, 73.80% in patient encounter skill, 82.84% in clinical decision-making skill and 87.58% in clinical procedure skill. Higher age groups, longer years of experience and participants from Terai region found to be associated with lower retention of knowledge. A better enabling environment and higher case load retained higher patient encounter skill. Conclusions: The competency retention among Mid-level Practicum trained mid-level health workers was found to be higher. Factors found associated with competency retention were age, geographic region, years of experience, case load and enabling environment.
Purpose: Nepal's 2017 Disability Rights law provided a new national definition of disability cons... more Purpose: Nepal's 2017 Disability Rights law provided a new national definition of disability consistent with the UN Convention on the Rights of Persons with Disabilities (CRPD). Updated measurement methods are now indicated to assess disability, suitable for use in populations where self-report tools may be sub-optimal. This study describes the development and field testing of a screening methodology using a clinical assessment conducted by trained nonprofessionals to score the ICF Minimal Generic Set (MGS). Method: A prospective, 2-stage assessment of disability was conducted over an eight-month period among a convenience sample of individuals aged ≥ 18, admitted to a rural District Hospital in Northeastern Nepal. After 30 hours of training, non-professional assessors completed Stage 1 screening during hospital admission, with positive screening thresholds set on the basis of MGS scores. A physiotherapist completed Stage 2 assessments in the homes of participants with long-term disability, after their hospital discharge. Results: Data from 161 participants was analysed, with 159 (98.8%) screening positive for either temporary or long-term disability. Stage 1 screening was completed independently by assessors in 8-12 minutes. Of the 35 participants (21.7%) with positive screening for long-term disability, 13 (37.1%) underwent Stage 2 detailed evaluation. Disability was confirmed in all Stage 2 assessments, indicating feasibility of the screening process.
Background and Objective: Over 300 000 women worldwide die due to pregnancyrelated complications ... more Background and Objective: Over 300 000 women worldwide die due to pregnancyrelated complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth. While MWHs have existed for decades, evidence regarding their effectiveness in reducing adverse birth outcomes has been mixed. The objective of this study is to comprehensively assess all available MWH research reporting quantitative maternal and childbirth data to determine whether MWHs are an effective maternal health strategy in resource-limited settings. Methodology: We conducted a scoping review and meta-analysis of existing literature on MWHs according to PRISMA guidelines. Descriptive statistics and odds ratios were calculated for the following birth outcomes: maternal mortality, perinatal mortality, and caesarian section. Quantitative analysis was conducted in RStudio and Stata Version 16. Results: One hundred seventy-one records were retrieved from our initial database search, of which 66 were identified as relevant. Only 15 of these records reported quantitative data on the health outcomes of interest and therefore met inclusion criteria for our metaanalysis. All studies reporting maternal mortality demonstrated a protective effect of MWHs (aggregate OR: 0.19 [0.10, 0.40]), as did all studies reporting perinatal mortality (aggregate OR: 0.29 [0.16, 0.53]). Studies reporting caesarian section were more varied and indicated less of a protective effect (aggregate OR: 1.80 [1.18, 2.75]). Conclusions: There is some indication that MWHs are an effective strategy for reducing maternal and perinatal mortality in resource-limited settings. However, our analysis was constrained by the observational design of most prior MWH studies. More rigorous MWH evaluations, ideally in the form of randomized-control trials, are needed to better determine MWH effectiveness. 2 Smith et al.
Research article Mental health of returnees: refugees in Germany prior to their state-sponsored r... more Research article Mental health of returnees: refugees in Germany prior to their state-sponsored repatriation
International journal for quality in health care : journal of the International Society for Quality in Health Care, 2021
BACKGROUND Nepal has made significant strides in maternal and neonatal mortality over the last th... more BACKGROUND Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the antenatal care process across the patients' socio-economic gradient. METHODS We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all seven provinces) and 198 women seeking ANC, and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic...
Background: Medical equipment plays a crucial role in the provision of quality healthcare service... more Background: Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal.Methods: We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T-tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews an...
I would like to recognize Mr. M. Antonio G. Alvarez, who introduced me to the Myron B. Thompson S... more I would like to recognize Mr. M. Antonio G. Alvarez, who introduced me to the Myron B. Thompson School of Social Work. My highest regard for Dr. Paula T. Morelli, PhD Program Chair. I am also indebted to my professors and colleagues. A big mahalo to Mr. Morris Kimo Lai, for providing me full access to Curriculum Research and Development Group (CRDG) library. I am forever grateful to the key community leaders and gatekeepers who permitted me to conduct this study in their communities. They also guided and supported my work while sharing their perspectives and mana'o. I would like to extend my deepest aloha and mahalo to many people including Dr. Mary F. Oneha (Waimanalo Health Center); Mr. Paul L. Richards (Association of Hawaiian Civic Clubs); Ms. Joelene K. Lono (Ke Ola Mamo); Mrs. Adrienne Dillard (Kula no na Po'e Hawai'i); Anake Bridget Puni Kekauoha (Papakolea Community Development Corporation); kahu Roy Brooks and late kahu Ryan Kalama (Hawaiian Civic Club of Waimanalo and Waimanalo Hawaiian Homestead Association); Mr. Josiah Ho'ohuli "Uncle Black" (Nanakuli Hawaiian Homestead Community Association) and Mrs. Tercia Ku (Princess Kahanu Estates Hawaiian Homestead Association) at Maili. Last but not least, I am so blessed to have had the support of my parents, sisters and brothers, my wife Ekta and our daughter Menjam for their dedication, unconditional support, patience, understanding and encouragement during this critical time. Mahalo to other extended 'ohana (family) members.
Cultural safety is a strengths-based construct which aims to subvert unequal power relations, hon... more Cultural safety is a strengths-based construct which aims to subvert unequal power relations, honor diverse ways of knowing in community-specific contexts, and acknowledge community as arbiter of 'how' safety is actualized. Published literature documents the benefits of culturally safe healthcare yet pays scant attention to culturally safe research praxis. Our team of practitionerresearchers sought to uncover meanings of cultural safety in community-based health research with Hawaiian Homestead residents. Focus groups were conducted in three communities. Emic descriptions of cultural safety and non-resident researchers were elicited. Content analysis revealed trust (hilina'i) as the overarching theme fundamental to cultural safety. Cultural safety was demonstrated by practices that accommodate and engage community in their shared sense of place, history, ways of knowing, and capacity-building. Such practices likely mitigate perceptions of cultural imposition and promote relevant interventions developed with communities. Implications are enunciated in HILINA'I, a mnemonic for advancing knowledge decolonization and health equity. BACKGROUND SIGNIFICANCE CULTURAL SAFETY AND RESEARCH PRAXIS Cultural safety or kawa whakaruruhau in the Maori language is a construct borne from the experiences of Indigenous nurses who witnessed their non-Maori colleagues attribute poor
Background-The incidence of non-AIDS-defining cancers has increased significantly among persons l... more Background-The incidence of non-AIDS-defining cancers has increased significantly among persons living with HIV (PLHIV). Screening education is recommended. Purpose-Social learning, minority stress, and cultural safety theories informed this pilot to assess the feasibility of a colorectal cancer screening intervention targeted to PLHIV, with additional tailoring for relevance to Native Hawaiians, a group with low participation in cancer screening. Method-The targeted education included behavioral modeling and barriers counseling in a culturally safe environment. Using a 2-group, pre/posttest design, AIDS service organizations were randomized to culturally responsive or standard education. AIDS service organizations consumers recruited through venue-based promotions were the unit of analysis. Knowledgeattitudes-practices, fecal occult blood test screening completion, and intervention feasibility were measured. Results-Treatment arm participants, regardless of ethnicity, adhered to fecal occult blood test instructions and achieved increases in screening knowledge, attitudes, and practices. Relevance and acceptability of the educational intervention were endorsed. Discussion-The culturally responsive intervention was successful in this group of PLHIV. Additional tailoring may be needed to reach PLHIV who do not participate in organizational activities. Conclusion/Translation to Health Education Practice-This culturally responsive intervention shows promise for efficacy testing in a broader PLHIV population. Constituentinvolving strategies were central to its development and delivery. The increasing incidence of non-AIDS-defining cancers (NADCs) is of significant concern in the present landscape of cancer control for persons living with HIV (PLHIV). 1-5 NADCs are all malignancies other than invasive cervical cancer, Kaposi's sarcoma, and non-Hodgkin's lymphoma, the latter of which are defining conditions for a diagnosis of AIDS. Between 1991 and 2005, NADC cases in PLHIV increased 3-fold, whereas incidence of AIDS-defining cancers dramatically declined. 5 Ten NADCs appear to contribute substantially to the cancer burden among PLHIV, including anal, colorectal, liver, lung, mouth and throat, renal, skin, and vaginal cancers; Hodgkin's lymphoma; and leukemia. 4 As in the seronegative population, NADCs among PLHIV tend to be associated with older age. However, PLHIV are more likely to develop NADCs at a younger age than persons who are
Community-based participatory research provides communities and researchers with opportunities to... more Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful results among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning ...
Significance: The Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED) i... more Significance: The Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED) is governed by the Cancer Council of the Pacific Islands (CCPI), a regional coalition representing health sector leadership from the US Affiliated Pacific Islands (USAPI). CCPI provides regional planning, policy guidance and program coordination for the 10 USAPI Comprehensive Cancer Control Coalitions, the Regional Comprehensive Cancer Control Program (RCCP) and the Pacific Regional Central Cancer Registry (PRCCR). Objective: Pacific CEED is funded by REACH US to support the regional coalition and evaluate cancer prevention and control activities and outcomes in the Pacific region and the USAPI. Methods: The CCPI is conducting a self-assessment to evaluate satisfaction with coalition functioning, perception of sustainability and regional leadership for cancer prevention and control, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific. The ...
The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated ... more The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated Pacific Islands (USAPI) to implement the Regional Comprehensive Control Plan: 2007-2012, and to evaluate its coalition and partnerships. The Pacific Center of Excellence in the Elimination of Disparities (CEED), aims to reduce cancer disparities and conducts evaluation activities relevant to cancer prevention and control in the USAPI. The PRCC Self (internal) and Partner (external) Assessments were conducted to assess coalition functioning, regional and national partnerships, sustainability, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific. Self-administered questionnaires and key informant telephone interviews with PRCC members (N=20), and representatives from regional and national partner organizations were administered (N=26). Validated multi item measures using 5-point scales on coalition and partnership characteristics were used. ...
The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce de... more The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was...
Journal of Nepal Health Research Council, Jun 2, 2022
Background: Mid-level health workers are deployed in a large proportion with the expectation of s... more Background: Mid-level health workers are deployed in a large proportion with the expectation of similar patient outcomes as with physicians. Mid-level practitioners are Health Assistants and Auxiliary Health Workers who provide clinical care at remote locations. National Health Training Center has been providing 60 days in-service Mid-level Practicum training since 2009 AD for the mid-level practitioners with the aim to enhance quality of patient care in Nepal. Methods: An observational study conducted using retrospective data from onsite follow-up assessment of 180 Mid-level Practitioner from 18 districts of Nepal between July 2015 to June 2019. The retention of competency onsite follow-up was calculated as percentage of assessment score at the end of Mid-level Practicum training. Percentage retention of competency and association of retention with factors were analyzed using independent t-test. Results: Majority of participants were male (85.6%), and working in a Health Post (84.4%). Average clinical competency retention in each domain at their work place was 68.79% in knowledge, 73.80% in patient encounter skill, 82.84% in clinical decision-making skill and 87.58% in clinical procedure skill. Higher age groups, longer years of experience and participants from Terai region found to be associated with lower retention of knowledge. A better enabling environment and higher case load retained higher patient encounter skill. Conclusions: The competency retention among Mid-level Practicum trained mid-level health workers was found to be higher. Factors found associated with competency retention were age, geographic region, years of experience, case load and enabling environment.
Purpose: Nepal's 2017 Disability Rights law provided a new national definition of disability cons... more Purpose: Nepal's 2017 Disability Rights law provided a new national definition of disability consistent with the UN Convention on the Rights of Persons with Disabilities (CRPD). Updated measurement methods are now indicated to assess disability, suitable for use in populations where self-report tools may be sub-optimal. This study describes the development and field testing of a screening methodology using a clinical assessment conducted by trained nonprofessionals to score the ICF Minimal Generic Set (MGS). Method: A prospective, 2-stage assessment of disability was conducted over an eight-month period among a convenience sample of individuals aged ≥ 18, admitted to a rural District Hospital in Northeastern Nepal. After 30 hours of training, non-professional assessors completed Stage 1 screening during hospital admission, with positive screening thresholds set on the basis of MGS scores. A physiotherapist completed Stage 2 assessments in the homes of participants with long-term disability, after their hospital discharge. Results: Data from 161 participants was analysed, with 159 (98.8%) screening positive for either temporary or long-term disability. Stage 1 screening was completed independently by assessors in 8-12 minutes. Of the 35 participants (21.7%) with positive screening for long-term disability, 13 (37.1%) underwent Stage 2 detailed evaluation. Disability was confirmed in all Stage 2 assessments, indicating feasibility of the screening process.
Background and Objective: Over 300 000 women worldwide die due to pregnancyrelated complications ... more Background and Objective: Over 300 000 women worldwide die due to pregnancyrelated complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth. While MWHs have existed for decades, evidence regarding their effectiveness in reducing adverse birth outcomes has been mixed. The objective of this study is to comprehensively assess all available MWH research reporting quantitative maternal and childbirth data to determine whether MWHs are an effective maternal health strategy in resource-limited settings. Methodology: We conducted a scoping review and meta-analysis of existing literature on MWHs according to PRISMA guidelines. Descriptive statistics and odds ratios were calculated for the following birth outcomes: maternal mortality, perinatal mortality, and caesarian section. Quantitative analysis was conducted in RStudio and Stata Version 16. Results: One hundred seventy-one records were retrieved from our initial database search, of which 66 were identified as relevant. Only 15 of these records reported quantitative data on the health outcomes of interest and therefore met inclusion criteria for our metaanalysis. All studies reporting maternal mortality demonstrated a protective effect of MWHs (aggregate OR: 0.19 [0.10, 0.40]), as did all studies reporting perinatal mortality (aggregate OR: 0.29 [0.16, 0.53]). Studies reporting caesarian section were more varied and indicated less of a protective effect (aggregate OR: 1.80 [1.18, 2.75]). Conclusions: There is some indication that MWHs are an effective strategy for reducing maternal and perinatal mortality in resource-limited settings. However, our analysis was constrained by the observational design of most prior MWH studies. More rigorous MWH evaluations, ideally in the form of randomized-control trials, are needed to better determine MWH effectiveness. 2 Smith et al.
Research article Mental health of returnees: refugees in Germany prior to their state-sponsored r... more Research article Mental health of returnees: refugees in Germany prior to their state-sponsored repatriation
International journal for quality in health care : journal of the International Society for Quality in Health Care, 2021
BACKGROUND Nepal has made significant strides in maternal and neonatal mortality over the last th... more BACKGROUND Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the antenatal care process across the patients' socio-economic gradient. METHODS We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all seven provinces) and 198 women seeking ANC, and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic...
Background: Medical equipment plays a crucial role in the provision of quality healthcare service... more Background: Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal.Methods: We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T-tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews an...
I would like to recognize Mr. M. Antonio G. Alvarez, who introduced me to the Myron B. Thompson S... more I would like to recognize Mr. M. Antonio G. Alvarez, who introduced me to the Myron B. Thompson School of Social Work. My highest regard for Dr. Paula T. Morelli, PhD Program Chair. I am also indebted to my professors and colleagues. A big mahalo to Mr. Morris Kimo Lai, for providing me full access to Curriculum Research and Development Group (CRDG) library. I am forever grateful to the key community leaders and gatekeepers who permitted me to conduct this study in their communities. They also guided and supported my work while sharing their perspectives and mana'o. I would like to extend my deepest aloha and mahalo to many people including Dr. Mary F. Oneha (Waimanalo Health Center); Mr. Paul L. Richards (Association of Hawaiian Civic Clubs); Ms. Joelene K. Lono (Ke Ola Mamo); Mrs. Adrienne Dillard (Kula no na Po'e Hawai'i); Anake Bridget Puni Kekauoha (Papakolea Community Development Corporation); kahu Roy Brooks and late kahu Ryan Kalama (Hawaiian Civic Club of Waimanalo and Waimanalo Hawaiian Homestead Association); Mr. Josiah Ho'ohuli "Uncle Black" (Nanakuli Hawaiian Homestead Community Association) and Mrs. Tercia Ku (Princess Kahanu Estates Hawaiian Homestead Association) at Maili. Last but not least, I am so blessed to have had the support of my parents, sisters and brothers, my wife Ekta and our daughter Menjam for their dedication, unconditional support, patience, understanding and encouragement during this critical time. Mahalo to other extended 'ohana (family) members.
Cultural safety is a strengths-based construct which aims to subvert unequal power relations, hon... more Cultural safety is a strengths-based construct which aims to subvert unequal power relations, honor diverse ways of knowing in community-specific contexts, and acknowledge community as arbiter of 'how' safety is actualized. Published literature documents the benefits of culturally safe healthcare yet pays scant attention to culturally safe research praxis. Our team of practitionerresearchers sought to uncover meanings of cultural safety in community-based health research with Hawaiian Homestead residents. Focus groups were conducted in three communities. Emic descriptions of cultural safety and non-resident researchers were elicited. Content analysis revealed trust (hilina'i) as the overarching theme fundamental to cultural safety. Cultural safety was demonstrated by practices that accommodate and engage community in their shared sense of place, history, ways of knowing, and capacity-building. Such practices likely mitigate perceptions of cultural imposition and promote relevant interventions developed with communities. Implications are enunciated in HILINA'I, a mnemonic for advancing knowledge decolonization and health equity. BACKGROUND SIGNIFICANCE CULTURAL SAFETY AND RESEARCH PRAXIS Cultural safety or kawa whakaruruhau in the Maori language is a construct borne from the experiences of Indigenous nurses who witnessed their non-Maori colleagues attribute poor
Background-The incidence of non-AIDS-defining cancers has increased significantly among persons l... more Background-The incidence of non-AIDS-defining cancers has increased significantly among persons living with HIV (PLHIV). Screening education is recommended. Purpose-Social learning, minority stress, and cultural safety theories informed this pilot to assess the feasibility of a colorectal cancer screening intervention targeted to PLHIV, with additional tailoring for relevance to Native Hawaiians, a group with low participation in cancer screening. Method-The targeted education included behavioral modeling and barriers counseling in a culturally safe environment. Using a 2-group, pre/posttest design, AIDS service organizations were randomized to culturally responsive or standard education. AIDS service organizations consumers recruited through venue-based promotions were the unit of analysis. Knowledgeattitudes-practices, fecal occult blood test screening completion, and intervention feasibility were measured. Results-Treatment arm participants, regardless of ethnicity, adhered to fecal occult blood test instructions and achieved increases in screening knowledge, attitudes, and practices. Relevance and acceptability of the educational intervention were endorsed. Discussion-The culturally responsive intervention was successful in this group of PLHIV. Additional tailoring may be needed to reach PLHIV who do not participate in organizational activities. Conclusion/Translation to Health Education Practice-This culturally responsive intervention shows promise for efficacy testing in a broader PLHIV population. Constituentinvolving strategies were central to its development and delivery. The increasing incidence of non-AIDS-defining cancers (NADCs) is of significant concern in the present landscape of cancer control for persons living with HIV (PLHIV). 1-5 NADCs are all malignancies other than invasive cervical cancer, Kaposi's sarcoma, and non-Hodgkin's lymphoma, the latter of which are defining conditions for a diagnosis of AIDS. Between 1991 and 2005, NADC cases in PLHIV increased 3-fold, whereas incidence of AIDS-defining cancers dramatically declined. 5 Ten NADCs appear to contribute substantially to the cancer burden among PLHIV, including anal, colorectal, liver, lung, mouth and throat, renal, skin, and vaginal cancers; Hodgkin's lymphoma; and leukemia. 4 As in the seronegative population, NADCs among PLHIV tend to be associated with older age. However, PLHIV are more likely to develop NADCs at a younger age than persons who are
Community-based participatory research provides communities and researchers with opportunities to... more Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful results among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning ...
Significance: The Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED) i... more Significance: The Pacific Center of Excellence in the Elimination of Disparities (Pacific CEED) is governed by the Cancer Council of the Pacific Islands (CCPI), a regional coalition representing health sector leadership from the US Affiliated Pacific Islands (USAPI). CCPI provides regional planning, policy guidance and program coordination for the 10 USAPI Comprehensive Cancer Control Coalitions, the Regional Comprehensive Cancer Control Program (RCCP) and the Pacific Regional Central Cancer Registry (PRCCR). Objective: Pacific CEED is funded by REACH US to support the regional coalition and evaluate cancer prevention and control activities and outcomes in the Pacific region and the USAPI. Methods: The CCPI is conducting a self-assessment to evaluate satisfaction with coalition functioning, perception of sustainability and regional leadership for cancer prevention and control, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific. The ...
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Papers by Suresh Tamang