MODELS FOR PRACTICE
FOCUS
AREA: CANCER
Location: Wailuku, Hawaii
Healthy People 2010 Objective: 3
Web Address: http://www.HuiNo.org
Hui No Ke Ola Pono is a
private, non-profit, health enhancement agency. It is a community-based
501(c)(3) organization that serves uninsured or underinsured Native Hawaiian,
Pacific Islander, and Filipino women. The agency is accredited by the
Commission of Accreditation for Rehab Facilities (CARF). The Kokua Cancer Program is one of many programs
of Hui No Ke Ola Pono; other programs are prenatal education, diabetes
self-management, and nutrition. The Kokua Program provides breast and cervical
cancer education presentations through outreach, enrollment with individuals,
‘ohana’ (family), or with various organizations. Services provided include
clinical breast exams (CBE), Pap tests, mammogram screening, blood pressure
screening, glucose screening, cholesterol screening, transportation, and case
management that consists of following up through resolution of abnormal results
or diagnosis and treatment. The geographic service area is the island of Maui
covering 727 square miles, with a total population of 117,644. There are 33,093
Native Hawaiians and part-Hawaiians in Maui County. Maui’s geography is varied
and poses significant problems when planning for networking and outreach, and
it constitutes an accessibility problem for residents.
Kokua’s paid staff consists
of a registered nurse who is also a health educator and clinical case manager,
a program coordinator, two outreach health care workers, and a clerk
receptionist. Hui’s Medical Director and program medical doctor donate their
time for clinical and case management to the Kokua Program. The volunteer staff
for the Kokua Program consists of seven gatekeepers to access the Native
Hawaiian community, Pacific Islander community, Tongan community, and Filipino
community. These gatekeepers provide information to the program staff on the
communities’ culture, beliefs, norms, traditions, customs, history, and
language and also volunteer as interpreters.
Making a Difference: The program’s
goals are measured against two Healthy People 2010 outcomes and outreach
targets: 1) increase to 70 percent the proportion of female clients aged 40+
who have had a clinical breast exam and a mammogram within the preceding two
years and who have been instructed in self breast exams; and 2) increase, to at
least 95 percent, the proportion of female clients age 18 and older who have
ever had a Pap test and increase to at least 90 percent those who received a
Pap test within the preceding three years.
Outreach:
The program is based on the Hawaiian value “Kokua” (helping each other). The
focus of the program is to outreach and educate women who have not participated
in regular screenings. One outreach strategy is to use ‘ohana’ (family) style
outreach to three or four women of the same family or friends helping the women
feel more comfortable. This works for the Pacific Islanders also.
Enrollment: A
clinical intake and education approach are used as a bridge between traditional
Hawaiian culture and medicine and Western medicine. This is accomplished by
providing health education in a “talk-story” manner that demystifies Western
clinical practices. In Hawaii, “talk-story” is an important social convention
for sharing information informally, finding common ground, and getting to know
each other. The staff have established close relationships with this target
group of women and have gained their trust.
Completing
the Screening: One-stop screening is achieved by scheduling the
CBE, Pap test, and mammogram screening on the same day. The convenience of
one-stop screening is attractive, especially because women find it hard to take
off work, find childcare, etc.
Providing transportation eliminates geographical barriers. Clients are
picked up and transported, scheduling five and six women at a time. The ‘ohana’
style scheduled screening for family and friends, with same day Pap test and
mammogram screening, helps eliminate fear and shame.
Makana
(gifts) are given as incentives after the women complete the Pap test and
mammogram screening. The first year of the program, t-shirts with the program’s
logo was given. The second year, a tote bag with the program’s logo were given.
Tracking
and Case Management: The Health Pro Database is used to manage
the client roster, results, and tracking of clinical encounters. A program/case
management algorithm was developed to show the flow of clients from education
and outreach through basic case management and, if needed, resolution or
treatment and intermediate case management with the case management team.
Performance
Measurement: The program has also established outreach target goals for
Hawaiian, Pacific Islander, and Filipino women.
Beginnings: Pre-grant meetings and a series of focus groups composed of
underserved women set about to address the questions of defining barriers to
cancer screening in the region. A survey was developed to gauge clients, the
community, and program partners. A Maui Cancer Research Team performed a study
to determine motivational factors and specific barriers to breast and cervical
cancer screening.
Challenges and Solutions: Barriers encountered include: cultural
beliefs regarding health, language, fear, shame, mistrust of Western medicine,
financial, accessing health care services, limited knowledge of available
health resources, and geographic isolation in remote rural areas.
The
majority of the population in the service area mistrust Western medicine. The
staff provides culturally sensitive services and clinical counseling by
focusing on outreach services, which integrate modern medical care with
traditional Hawaiian values, beliefs, and practices.
95
Mahalani Street, Room 21
Wailuku,
HI, 96793
Phone:
(808) 244-4647
Fax:
(808) 222-6676