A Qualitative Exploration of Health and Cancer-Related Experiences Among Native Hawaiian Adults
Keywords:Cancer, health care, family, experiences, coping, stress, social-ecological model, resilience
Cancer disproportionately affects the Native Hawaiian community. Understanding health and cancer-related experiences of Native Hawaiian adults may inform effective health interventions to improve quality of life for cancer survivors in this community. Qualitative methodologies guided the exploration of health and cancer-related experiences from the perspectives of four Native Hawaiian adults with cancer experiences and three Native Hawaiian adults without cancer-related experiences (n = 7). Based on the Social-Ecological Model, four core themes emerged: (1) Individual health including an understanding of health and responsibility for individual health; (2) Social support; (3) Knowing there are options; and (4) Spirituality and reflections of the Native Hawaiian community. This study provided strong evidence that family has a substantial role in the perspectives of health for Native Hawaiians. Participants with cancer-related experiences reported resilience, coped with medical adversities in positive ways, expressed a deeper appreciation for life, and relied heavily on Akua and spirituality compared to those without cancer-related experiences. Based on the findings, cancer programs that honor Native Hawaiian perspectives of health, family, and cultural values in healthcare may play a central role in cancer prevention and treatment, reducing overall cancer burden in this community. Findings contribute to literature focusing on familial and cultural components of Native Hawaiian health in the context of cancer care. Despite the remarkable growth in literature on Native Hawaiian and Pacific health, cancer burden remains high. Future directions include better alignment of research with culture and Native Hawaiian worldviews of health that may enhance overall quality of life.
Aitaoto, N., Braun, K. L., Estrella, J., Epeluk, A., & Tsark, J. U. (2012). Design and results of a culturally tailored cancer outreach project by and for Micronesian women. Preventing Chronic Disease, 9(4), 1-8. http://dx.doi.org/10.5888/pcd9.100262
Aitaoto, N., Braun, K. L., Tomiyasu, D. W., Tsark, J. U., & Yamashita, B. (2009). Strategies to
increase breast and cervical cancer screening among Hawaiian, Pacific Islander, and
Filipina women in Hawai‘i. Hawai‘i Medical Journal, 68(9), 215-222.
American Cancer Society. (2021). Cancer facts & figures 2021. Atlanta: American Cancer Society, Inc. 2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf
Braun, K. L., Mokuau, N., Hunt, G. H., Kaanoi, M., & Gotay, C. C. (2002). Supports and
obstacles to cancer survival for Hawai‘i’s Native People. Cancer Practice, 10(4),
Calumet, K. M. (2017). Breast cancer, mana’olana/hope, and the experience of Native Hawaiian women (Publication No. 4354) [Doctoral dissertation, Walden University]. Walden
Dissertations and Doctoral Studies. https://scholarworks.waldenu.edu/dissertations/4354/
Curry, S. J., Byers, T., & Maria, H. (2003). Fulfilling the potential of cancer prevention and early detection. Washington (DC): National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK223926/
Eide, P. (2006). Native Hawaiian women and the experience of breast cancer. Women & Health,
(4), 41-59. https://doi.org/10.1300/J013v44n04_03
Emmel, N. (2013). Sampling and choosing cases in qualitative research: A realist approach.
SAGE Research Methods. https://dx.doi.org/10.4135/9781473913882
Green, M. D. (2010, September). Hawai‘i cancer facts & figures 2010: A sourcebook for
planning & implementing programs for cancer prevention & control. Honolulu, HI:
American Cancer Society, Cancer Research Center of Hawai‘i & Hawai‘i State
Department of Health.
Hawai‘i Health Matters. (2017, February). Breast cancer death rate. Retrieved from
Hawai‘i Health Matters. (2017, February). Lung cancer death rate. Retrieved from
Ho, R., Muraoka, M., Cuaresma, C., Guerrero, R., & Agbayani, A. (2010). Addressing the
excess breast cancer mortality in Filipino women in Hawai‘i through AANCART, an NCI Community Network Program. Hawai‘i Medical Journal, 69(7), 164-166.
Hughes, C. K., & Higuchi, P. (2004). Ka Lōkahi Wāhine: A culturally based training for health
professionals. Pacific Health Dialog, 11(2), 166-169.
Ka‘opua, L. S. (2008). Developing a culturally responsive breast cancer screening promotion
with Native Hawaiian women in churches. Health & Social Work, 33(3), 169-177.
Ka‘opua, L. S., Mitschke, D. B., & Kloezeman, K. C. (2008). Coping with breast cancer at the
nexus of religiosity and Hawaiian culture: Perspectives of Native Hawaiian survivors and
family members. Journal of Religion & Spirituality in Social Work: Social Thought,
(3), 275-295. https://doi.org/10.1080/15426430802202187
Look, M. A., Trask-Batti, M. K., Agres, R., Mau, M. L., & Kaholokula, J. K. (2013). Assessment
and priorities for health & well-being in Native Hawaiians & other Pacific peoples.
Honolulu, HI: Center for Native and Pacific Health Disparities Research, University of
Mokuau, N., & Braun, K. L. (2007). Family support for Native Hawaiian women with breast cancer. Journal of Cancer Education, 22(3), 191-196.
Mokuau, N., Braun, K. L., & Daniggelis, E. (2012). Building family capacity for Native Hawaiian women with breast cancer. Health & Social Work, 37(4), 216-224.
Mokuau, N., Braun, K. L., Wong, L. K., Higuchi, P., & Gotay, C. C. (2008). Development of a
family intervention for Native Hawaiian women with cancer: A pilot study. Social Work,
(1), 9-19. https://doi.org/10.1093/sw/53.1.9
Native Hawaiian Health Task Force. (2017). Native Hawaiian Health Task Force report: Highlights and recommendations. https://www.hawaii.edu/govrel/docs/briefings/2017/nhhtf_briefing-factsheet_01-17-17_hre-hwn-cph.pdf
Paglinawan, L. K., Paglinawan, R. K., Kauahi, D., Kanuha, V., Kalahele, I., & Pukui, M. K. (2020). Nānā i ke kumu. Helu‘ekolu = Volume three . Lili‘uokalani Trust.
Santos, L., Mokuau, N., Abrigo, L., Braun, K. L., Tsark, J. U., Mackura, G., Kuhaulua, R., &
Chong, C. D. (2001). ‘Imi Hale: Establishing an inheritance for Native Hawaiians on
cancer awareness, research and training. Pacific Health Dialog, 8(2), 436-445.
Taparra, K., Miller, R. C., & Jr, C. D. (2021). Navigating Native Hawaiian and Pacific Islander
cancer disparities from a cultural and historical perspective. American Society of Clinical
Oncology, 17(3), 130-134. https://doi.org/10.1200/OP.20.00831