Decolonizing Knowledge Development In Health Research Cultural Safety Through The Lens Of Hawaiian Homestead Residents
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 practitioner-researchers 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.
Australian Government, Department of Health (2008). Australian Health Ministers Conference. Retrieved July 1, 2015 from http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept180408.htm
Ball, J. (2015). Cultural safety in practice with children, families, and communities. University of Victoria. Retrieved July 1, 2015 from http://www.ecdip.org/culturalsafety/
Braun, K. L., Browne, C. V., Ka‘opua, L. S., Kim, B. J., & Mokuau, N. (2014). Research on indigenous elders: From positivistic to decolonizing methodologies. The Gerontologist, 54 (1), 117-126. doi:10.1093/geront/gnt067. PMID: 23841952, PMCID: PMC3894850.
Browne, A. J., Smye, V. L., & Varcoe, C. (2005). The relevance of postcolonial theoretical perspectives to research in Aboriginal health. Canadian Journal of Nursing Research, 37(4), 16-37. PMID: 16541817. Retrieved July 1, 2015 from http://www.ncbi.nlm.nih.gov/pubmed/16541817
Burhansstipanov, L., & Christopher, S., Schumacher, A. (2005). Lessons learned from community-based participatory research in Indian Country. Cancer Control, 12(2), 70–76. PMCID:PMC3544402, NIHMSID:NIHMS422566. Retrieved July 25, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544402/
Burnette, C. E., Sanders, S., Butcher, H. K., & Salois, E. M. (2011). Illuminating the lived experiences of research with indigenous communities. Journal of Ethnic & Cultural Aspects of Social Work, 20(4), 275-296. doi:10.1080/15313204.2011.622199. Retrieved July 26, 2015 from http://www.tandfonline.com/doi/full/10.1080/15313204.2011.622199#abstract
Burnette, C. E., & Sanders, S. (2014). Trust Development in Research with Indigenous Communities in the United States. The Qualitative Report, 19 (22), 1-19. Retrieved June 10, 2015 from http://nsuworks.nova.edu/tqr/vol19/iss22/2
Bushnell, O. A. (1993). The gifts of civilization: Germs and genocide in Hawai‘i. Honolulu, HI: University of Hawai‘i Press.
Christopher, S., Watts, V., McCormick, A. K. H. G., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American Journal of Public Health, 98(8), 1398-1406.
doi:10.2105/AJPH.2007.125757; PMCID:PMC: 2446462. Retrieved June 10, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2446462/
Cross T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care, volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center. Retrieved July 5, 2015 from http://files.eric.ed.gov/fulltext/ED330171.pdf
Dana, R. H., Behn, J. D., & Gonwa, T. (1992). A checklist for the examination of cultural competence in social service agencies. Research on Social Work Practice, 2(2), 220-233, doi:10.1177/104973159200200208
Duran, E. (2014). Preface. In L. Lambert (Ed.), Research for indigenous survival. Indigenous research methodologies in the behavioral sciences (xi-xiii). Lincoln, NE: University of Nebraska.
Goodyear-Ka‘ōpua, J. N. (2013). The seeds we planted: Portraits of a Native Hawaiian charter school. Minneapolis: University of Minnesota Press.
Kagawa-Singer M. (2009). Where is culture in cultural tailoring? In J. McMullin & D. Weiner, D. (Eds.) Confronting cancer: Metaphors, advocacy, and anthropology (pp. 207-29). Santa Fe, NM: School for Advanced Research Press.
Kamehameha Schools (2014). Ka huaka ‘i: 2014 Native Hawaiian educational assessment. Honolulu: Kamehameha Publishing.
Kame‘elehiwa, L (1992). Native land and foreign desires: Pehea lā e pono ai? Honolulu: Bishop Museum.
Ka‘opua LS (2003). Training community practitioners in a research intervention: Practice examples at the intersection of cancer, western science, and Native Hawaiian healing. Cancer Control, 10(5), 5-12. PMID: 14581899.
Ka‘opua, L. S. (2008). Developing a culturally-responsive breast cancer screening promotion with Native Hawaiian women in churches. Health & Social Work, 33(3), 169-77. PMID:18773792; PMCID: PMC2938766.
Ka‘opua, L. S., Braun, K. L., Browne, C. V., Mokuau, N, & Park, C. B. (2011-a). Why are Native Hawaiians underrepresented in Hawai‘i’s older adult population? Exploring social and behavioral factors of longevity. Journal of Aging Research. 1-8, PMID:21966592, PMCID: PMC3182069.
Ka‘opua, L.S.I., Cassel, K., Shiramizu, B., Stotzer, R.L., Robles, A., Kapua, C., Orton, M., Milne, C., & Sesepasara, M. (2015). Addressing risk and reluctance at the nexus of HIV and anal cancer screening. Health Promotion Practice, 17(1), 21-30. DOI: 10.1177/1524839915615611. PMID 26630979, PMC 4684716.
Ka‘opua, L. S., Diaz, T. P., Park, S. H., Bowen, T., Patrick, K., Tamang, S., & Braun K. L. (2014). Colorectal cancer screening at the nexus of HIV, minority statuses and cultural safety. American Journal of Health Education, 45(1), 42-51. PMID:24653993; PMCID:PMC3956657.
Ka‘opua, L.S., Goodyear-Ka‘ōpua, J.N., Ka‘awa, J.M., Amona, S.K., Browne, C.V., & Robles, A.S. (2016). Look to the source: Gathering elder stories as segue to youth action-oriented research. International Public Health Journal 8(2), 271-82.
Ka‘opua, L. S., Mitschke, D., & Lono, J. (2004). Increasing participation in cancer research: Insights from Native Hawaiian women in medically underserved communities. Pacific Health Dialog, 11(2), 170-5.
Ka‘opua, L. S., Park, S. H., Ward, M. E., & Braun, K. L. (2011-b). Testing the feasibility of a culturally tailored breast cancer screening intervention with Native Hawaiian women in rural churches. Health & Social Work, 36(1), 55-65. PMID: 21446609; PMCID:PMC3070905. doi:10.1093/hsw/36.1.55.
Kern, E. (2010). Sugarcane and lepers: Health policy and the colonization of Hawaii (1860-1900). Pen History Review, 17(2)5. University of Pennsylvania. Retrieved Feb 12, 2015 from http://repository.upenn.edu/phr/vol17/iss2/5/
Kline, C., Chhina, G., Godolphin, W., & Towle, A. (2013). Community as teacher model: Health profession students learn cultural safety from an Aboriginal community. Michigan Journal of Community Service Learning, 20(1), 5-17.
Krueger, R. A. (2002). Designing and conducting focus group interviews. St. Paul, MN: University of Minnesota. Retrieved January 10, 2013 from: www.eiu.edu/~ihec/Krueger-FocusGroupInterviews.pdf
Krippendorf, K. (1980). Content analysis: An introduction to its methodology. Beverly Hills, CA: Sage Publications.
Kula no na Po’e Hawai‘i (2008). Kawaihonaakealoha: Community report. Honolulu, HI: Author.
Lambert, L. (2014). Connecting the stories: themes and development of a conceptual model. In L. Lambert (Ed.), Research for indigenous survival. Indigenous research methodologies in the behavioral sciences (pp. 199-220). Lincoln, NE: University of Nebraska.
Lincoln, Y. S, & Guba, E. G. (1985). Naturalistic inquiry (1st ed.). Sage Publications.
LaVeaux, D. & Christopher, S. (2009). Contextualizing CBPR: Key principles of CBPR meet the indigenous research context. Pimatisiwin, 7(1), 1-25. PMCID: PMC2818123; NIHMSID: NIHMS144307. Retrieved June 12, 2015 from http://www.pimitisiwin.com/online/wp-content/uploads/2009/07/01Contents
Levy, N. M. (1975). Native Hawaiian Land Rights. California Law Review, 63(4). Retrieved June 12, 2015 from http://scholarship.law.berkeley.edu/californialawreview/vol63/ISS4/2
McCubbin, L. D. (2006). Indigenous values, cultural safety and improving healthcare: The case of Native Hawaiians. Contemporary Nurse Journal, 22(2), 214-217.
McGregor, D. P. (2007). Na kua‘aina: Living Hawaiian culture. Honolulu, HI: University of Hawai‘i Press.
Meyers, M. (2015). Kapu aloha for Maunakea, a discipline of compassion. University of Hawai‘i-Hilo Stories. Retrieved July 5, 2015 from http://hilo.hawaii.edu/news/stories/2015/04/13/kapu-aloha/
Minkler, M., & Wallerstein, N. (2008). Community-based participatory research for health: From process to outcomes (2nd ed). San Francisco: Jossey-Bass.
Model, S. W. (1985). A comparative perspective on the ethnic enclave: Blacks, Italians, and Jews in New York City. International Migration Review, 19(1), 64–81.
Mokuau, N., DeLeon, P., Kaholokula, J.K., Soares, S., Tsark, J.U., & Haia, C. (2016). Challenges and promise of health equity for Native Hawaiians. Perspectives. Expert Voices in Health and Health Care. WA DC: National Academy of Medicine. Retrieved Oct. 12, 2016 from: https://nam.edu/.../2016/.../Challenges-and-Promise-of-Health-Equity-for-Native-Hawaiians/
National Aboriginal Health Organization (NAHO). (2008). Cultural competency and safety: A guide for healthcare administrators, providers and educators. Ottawa: National Aboriginal Health Organization. Retrieved March 26, 2015 from www.naho.ca/publications/culturalCompetency.pdf
Nursing Council of New Zealand (2011). Guidelines for cultural safety, the Treaty of Waitangi and Maori health in nursing and midwifery education. Wellington. Retrieved May 7, 2015 from
Papps, E., & Ramsden, I. (1996). Cultural safety in nursing: The New Zealand experience. International Journal for Quality in Healthcare, 8(5), 491-497. doi:10.1093/intqhc/8.5.491. Retrieved June 5, 2015 from https://www.researchgate.net/publication/14101522_Cultural_safety_in_nursing_The_New_Zealand_experience
Reiss, J. (2015). Causation, evidence, and inference. London: Routledge.
Samovar, L. A. & Porter, R. E. (2004). Communication between cultures (4th ed.), Belmont, CA: Wadsworth.
Smith, P. S. (2010). Cultural safety in nursing education: Increasing care for LGBT individuals [Master’s thesis]. Spokane, WA: Washington State University. Retrieved April 20, 2015 from https://research.wsulibs.wsu.edu/xmlui/bitstream/handle/2376/3442/P_Smith_011018665.pdf
State of Hawai‘i, Department of Hawaiian Home Lands (2016). Hawaiian Homes Commission Act (1920). State of Hawaii: Retrieved July 1, 2016 from http://www.capitol.hawaii.gov/hrscurrent/vol01_ch0001-0042f/06-Hhca/HHCA_htm
State of Hawai‘i, Department of Hawaiian Home Lands (2014). DHHL leasee report 2014. Honolulu: author.
Tervalon, T. M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-25. doi:10.1353/hpu.2
United States Commission on Civil Rights. Hawaii Advisory Committee (1991). A broken trust: the Hawaiian homelands program: seventy years of failure of the federal and state governments to protect the civil rights of native Hawaiians. Baltimore, MD: University of Maryland, School of Law, Thurgood Marshall Law Library. Retrieved June 23 from http://www.law.umaryland.edu/Marshall/usccr/documents/cr12h313z.pdf
Williams, R. (1999). Cultural safety- What does it mean for our work practice? Australian and New Zealand Journal of Public Health, 23(2), 213-214. doi:10.1111/j.1467-842X.1999.tb01240.x
Wu. Y.Y., Braun, K., Onaka, A.T., Horiuchi, B.Y., Tottori, C.J., & Wilkens, L. (2017). Life expectancies in Hawai: A multiethnic analysis of 2010 life tables. Hawai‘i Journal of Medicine and Public Health, 78(1), 2-14. PMCID: PMC5226016