Examining elevated blood pressure and the effects of diabetes self-management education on blood pressure among a sample of Marshallese with type 2 diabetes in Arkansas

INTRODUCTION

Hypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders.

METHODS

This study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants' blood pressure, comparing an Adapted-Family DSME with a Standard DSME.

RESULTS

Nearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm.

CONCLUSION

This study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM.

Implementation outcomes of a culturally adapted diabetes self-management education intervention for Native Hawaiians and Pacific islanders

BACKGROUND

Native Hawaiians and Pacific Islanders (NHPIs) experience a disproportionate burden of type 2 diabetes and related complications. Although diabetes self-management education and support (DSMES) interventions have generally yielded positive results, few NHPIs have been included in these studies, and even fewer studies have been evaluated using a randomized controlled trial design and/or implementation research methods. The purpose of this pilot study was to evaluate implementation outcomes of a culturally adapted diabetes self-management education intervention delivered by peer educators to Native Hawaiians and Pacific Islanders residing in Honolulu, Hawai'i.

METHODS

In three study sites, the peer educators and 48 participants randomized to the intervention were invited to participate in the mixed methods implementation research. We used a convergent parallel design to collect implementation data including fidelity, feasibility, acceptability, appropriateness, adoption, and sustainability. Data were collected from class observations, participants' class feedback, and post-intervention focus groups with participants and peer educators.

RESULTS

In 314 end-of-class feedback surveys, 97% of respondents expressed that they were satisfied or highly satisfied with the class content and activities, 98% reported that the classes and materials were very useful, 94% reported very applicable, and 93% reported materials were culturally appropriate. Respondents identified several aspects of the program as especially enjoyable: interactions with peer educators, meeting in groups, learning about other participants' experiences with diabetes, and the information presented in each class. Major themes that emerged from the end-of-intervention focus groups were the relevance of the educational materials, strategies to manage blood glucose, hands-on activities, cultural aspects of the program, including the stories and analogies used to convey information, and appreciation of the group format and peer educators.

CONCLUSIONS

Results from this research support a culturally tailored, peer educator approach to DSMES among NHPIs. Delivery of the Partners in Care program is feasible in health care and community settings and is a reimbursable DSMES program.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01093924 prospectively registered 01.20.09.

Kaumātua Mana Motuhake Pōi: a study protocol for enhancing wellbeing, social connectedness and cultural identity for Māori elders

BACKGROUND

The Aotearoa New Zealand population is ageing accompanied by health and social challenges including significant inequities that exist between Māori and non-Māori around poor ageing and health. Although historically kaumātua (elder Māori) faced a dominant society that failed to realise their full potential as they age, Māori culture has remained steadfast in upholding elders as cultural/community anchors. Yet, many of today's kaumātua have experienced 'cultural dissonance' as the result of a hegemonic dominant culture subjugating an Indigenous culture, leading to generations of Indigenous peoples compelled or forced to dissociate with their culture. The present research project, Kaumātua Mana Motuhake Pōī (KMMP) comprises two interrelated projects that foreground dimensions of wellbeing within a holistic Te Ao Māori (Māori epistemology) view of wellbeing. Project 1 involves a tuakana-teina/peer educator model approach focused on increasing service access and utilisation to support kaumātua with the greatest health and social needs. Project 2 focuses on physical activity and cultural knowledge exchange (including te reo Māori--Māori language) through intergenerational models of learning.

METHODS

Both projects have a consistent research design and common set of methods that coalesce around the emphasis on kaupapa kaumatua; research projects led by kaumātua and kaumātua providers that advance better life outcomes for kaumātua and their communities. The research design for each project is a mixed-methods, pre-test and two post-test, staggered design with 2-3 providers receiving the approach first and then 2-3 receiving it on a delayed basis. A pre-test (baseline) of all participants will be completed. The approach will then be implemented with the first providers. There will then be a follow-up data collection for all participants (post-test 1). The second providers will then implement the approach, which will be followed by a final data collection for all participants (post-test 2).

DISCUSSION

Two specific outcomes are anticipated from this research; firstly, it is hoped that the research methodology provides a framework for how government agencies, researchers and relevant sector stakeholders can work with Māori communities. Secondly, the two individual projects will each produce a tangible approach that, it is anticipated, will be cost effective in enhancing kaumātua hauora and mana motuhake.

TRIAL REGISTRATION

Australia New Zealand Clinical Trial Registry ( ACTRN12620000316909 ). Registered 6 March 2020.

A scoping review of school-based indigenous substance use prevention in preteens (7-13 years)

BACKGROUND

Early-onset substance use is a risk factor for continued use, dependency, and poor long-term health outcomes. Indigenous youth are more likely to engage in early-onset substance use than their non-Indigenous counterparts. In Canada, culturally appropriate prevention programs are needed for Indigenous youth in elementary schools. Therefore, this scoping review aims to explore the published, international literature examining school-based substance use prevention programs for Indigenous children aged 7-13.

MAIN TEXT

Methods: This scoping review followed a six-step approach: 1) identifying the research questions, 2) identifying relevant studies, 3) selecting the studies, 4) charting the data, 5) collating, summarizing, and reporting the results, and 6) consulting with experts. The review was reported using guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR).

RESULTS

Eleven articles (3 Canadian; 7 American and; 1 Australian) were included in the review. The prevention programs they studied were based on existing research or were adapted from existing interventions. The programs were tailored to each communities' culture by including Indigenous stakeholders in developing or adapting prevention programs to be culturally safe and responsive. The articles evaluated the programs' Effectiveness in changing student knowledge, attitudes, and behaviors using pre- and post-intervention surveys, randomized control trials, longitudinally designed analysis, and mixed methods. Mixed quantitative findings and qualitative findings highlighted the programs' value in building community capacity and fostering cultural revitalization.

CONCLUSION

This review highlights best practices for developing school-based substance use prevention programs for Indigenous youth. Findings suggest that prevention programs should be culturally responsive and provide students with the knowledge and skills to prevent and manage substance use in real-life situations. Making Indigenous beliefs, values, languages, images, and worldviews central to the prevention curriculum enhanced the Effectiveness, appropriateness, and sustainability of prevention programs. Indigenous communities are best positioned to facilitate cultural tailoring without compromising the fidelity of evidence-based prevention programs.

Biospecimen Education Among Pacific Islanders in Southern California

Despite increasing rates of cancer, biospecimen donations for cancer research remains low among Pacific Islanders (PIs). To address this disparity, researchers partnered with PI community organizations to develop and test a theory-based culturally tailored educational intervention designed to raise awareness about the issues surrounding biospecimen research. A total of 219 self-identified PI adults in Southern California were recruited to participate in a one-group pre-post design study. Participants completed questionnaires that assessed their knowledge and attitude regarding biospecimen research before and after viewing an educational video and receiving print materials. Results showed that participants' overall knowledge and attitude increased significantly from pre-test to post-test (p < .0001). Over 98% of participants also reported that they would be willing to donate at least one type of biospecimen sample. Efforts such as these that utilize culturally tailored education interventions may be instrumental in improving biospecimen donation rates in the PI community as well as other minority populations.

A Unique Partnership Between the University of Hawai'i Cancer Center and the University of Guam: Fifteen Years of Addressing Cancer Health Disparities in Pacific Islanders in Hawai'i and Guam

This manuscript describes the efforts in research, education, and outreach of a unique partnership between the University of Hawai'i Cancer Center and the University of Guam in addressing cancer health disparities faced by Pacific Islanders in Hawai'i, Guam, and other parts of Micronesia. Significant accomplishments of this 15-year collaboration in research, training Micronesian students, and impact on the local communities are highlighted.

Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review

OBJECTIVE

To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people.

STUDY DESIGN

Systematic review of peer-reviewed literature.

DATA SOURCES

MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet.

STUDY SELECTION

Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots.

RESULTS

Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes.

CONCLUSIONS

Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation.

PROSPERO REGISTRATION NUMBER

CRD42015029551.

Australian Indigenous Land Management, Ecological Knowledge and Languages for Conservation

Many Indigenous Australians hold cultural, ecological and language knowledge, but common representations of Indigenous Australians focus on social disadvantage and poor comparisons with other Australians in education, employment and health. Indigenous Land Management works with Indigenous people's cultural, ecological and language expertise, employing Indigenous people in activities contributing to biodiversity conservation. The Interplay research surveyed 841 Indigenous people in remote communities. Those employed in land management reported greater participation in cultural activities, language knowledge, and belief that their land was looked after. These related assets provide an opportunity for policy approaches based on Indigenous people's strengths and contribution to Australia.

Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia

INTRODUCTION

The age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers.

METHODS AND ANALYSIS

This study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition/pregnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure.

ETHICS AND DISSEMINATION

The protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12618000188235; Pre-results.

The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study

BACKGROUND

In Australia there is commitment to developing interventions that will 'Close the Gap' between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families.

METHODS

Mothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families.

DISCUSSION

Involving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.

The positioning of Aboriginal students and their languages within Australia's education system: A human rights perspective

This paper is a critical review of past and present languages policies in Australian schooling. We highlight the One Literacy movement that contravenes the human rights of Australia's Aboriginal students. This in turn impacts students' right to freedom of opinion and expression as stated in Article 19 of the Universal Declaration of Human Rights. The One Literacy movement operates by equating Standard Australian English literacy acquisition with Australia's global competitiveness and economic success. There is only one pathway through the Australian English curriculum with common assessments and standards. However, the Australian Curriculum provides three distinctive pathways when students from an English-speaking background learn languages other than English. We reveal this double standard, where current educational policies prioritise the languages of trade (e.g. Chinese) and accommodate speakers of these languages. Meanwhile Aboriginal-language-speaking students are not provided with the same accommodations. For educational equity, there should be a distinctive English language learner pathway that recognises that the majority of remote Aboriginal students from the Northern Territory are learning English as an additional language. We advocate for these changes because all children have a right to an appropriate education that will enable them to flourish as learners and citizens.

Delivering an empowerment intervention to a remote Indigenous child safety workforce: Its economic cost from an agency perspective

BACKGROUND

The Family Wellbeing (FWB) program applies culturally appropriate community led empowerment training to enhance the personal development of Aboriginal and Torres Strait Islander people in life skills. This study sought to estimate the economic cost required to deliver the FWB program to a child safety workforce in remote Australian communities.

METHOD

This study was designed as a retrospective cost description taken from the perspective of a non-government child safety agency. The target population were child protection residential care workers aged 24 or older, who worked in safe houses in five remote Indigenous communities and a regional office during the study year (2013). Resource utilization included direct costs (personnel and administrative) and indirect or opportunity costs of participants, regarded as absence from work.

RESULTS

The total cost of delivering the FWB program for 66 participants was $182,588 ($2766 per participant), with 45% ($82,995) of costs classified as indirect (i.e., opportunity cost of participants time). Training cost could be further mitigated (∼30%) if offered on-site, in the community. The costs for offering the FWB program to a remotely located workforce were high, but not substantial when compared to the recruitment cost required to substitute a worker in remote settings.

CONCLUSION

An investment of $2766 per participant created an opportunity to improve social and emotional wellbeing of remotely located workforce. This cost study provided policy relevant information by identifying the resources required to transfer the FWB program to other remote locations. It also can be used to support future comparative cost and outcome analyses and add to the evidence base around the cost-effectiveness of empowerment programs.

2016 Writing Contest graduate Winner: Cardiovascular Disease Training for Community Health Workers Serving Native Hawaiians and Other Pacific Peoples

To help community health workers (CHW) meet increased demand for their services, it is essential to have data supported strategies for approaches to their training and capacity development. The objective of this paper is to report on the development, implementation, and evaluation of "Heart 101," a cardiovascular disease (CVD) training program, conducted among CHW in Hawai'i who serve Native Hawaiians and other Pacific Peoples (NHPP). Principles from Community-Based Participatory Research provided a framework to develop and implement the 5-hour training curriculum. Developers incorporated teaching strategies shown to be effective among learners that represent the majority of CHW, and included principles of adult learning theory and culture-based education. Training participants completed pre-, post-, and 6-months post-training knowledge tests, as well as demographic and participant satisfaction surveys. Data analysis based on pre- and post-training knowledge tests (n=30) indicated that Heart 101 significantly increased CVD knowledge by 32% (P < .001, t test). Long-term CVD competency measured at six-months post-training (n = 20) was also shown to be significant (P < .001, t test). Analysis of knowledge by subtopic suggested CHW strengths in clinical aspects of CVD and weaknesses in medical terminology and basic science aspects. These results, along with positive participant satisfaction, suggest that a culturally relevant and interactive course is a strong approach for CVD information dissemination to CHW serving NHPP communities, and provides insight on potential areas for special focus in their training. The demonstrated success of Heart 101 has positive implications for the standardization of CHW education and for their professional development.

Cultural Adaptation of Diabetes Self-Management Education for Marshallese Residing in the United States: Lessons Learned in Curriculum Development

BACKGROUND

Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity.

OBJECTIVES

We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese.

METHODS

Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts.

LESSONS LEARNED

Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality.

CONCLUSIONS

We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others' work with Pacific Islanders.

Patterns of privilege: A total cohort analysis of admission and academic outcomes for Māori, Pacific and non-Māori non-Pacific health professional students

BACKGROUND

Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to non-ethnic minority students) whilst privileging non-ethnic minority students and has important implications for health workforce and health equity priorities. Understanding the reasons for academic inequities is important to improve institutional performance. This study explores factors that impact on academic success for health professional students by ethnic group.

METHODS

Kaupapa Māori methodology was used to analyse data for 2686 health professional students at the University of Auckland in 2002-2012. Data were summarised for admission variables: school decile, Rank Score, subject credits, Auckland school, type of admission, and bridging programme; and academic outcomes: first-year grade point average (GPA), first-year passed all courses, year 2 - 4 programme GPA, graduated, graduated in the minimum time, and composite completion for Māori, Pacific, and non-Māori non-Pacific (nMnP) students. Statistical tests were used to identify significant differences between the three ethnic groupings.

RESULTS

Māori and Pacific students were more likely to attend low decile schools (27 % Māori, 33 % Pacific vs. 5 % nMnP, p < 0.01); complete bridging foundation programmes (43 % Māori, 50 % Pacific vs. 5 % nMnP, p < 0.01), and received lower secondary school results (Rank Score 197 Māori, 178 Pacific vs. 231 nMnP, p < 0.01) when compared with nMnP students. Patterns of privilege were seen across all academic outcomes, whereby nMnP students achieved higher first year GPA (3.6 Māori, 2.8 Pacific vs. 4.7 nMnP, p < 0.01); were more likely to pass all first year courses (61 % Māori, 41 % Pacific vs. 78 % nMnP, p < 0.01); to graduate from intended programme (66 % Māori, 69 % Pacific vs. 78 % nMnP, p < 0.01); and to achieve optimal completion (9 % Māori, 2 % Pacific vs. 20 % nMnP, p < 0.01) when compared to Māori and Pacific students.

CONCLUSIONS

To meet health workforce and health equity goals, tertiary institution staff should understand the realities and challenges faced by Māori and Pacific students and ensure programme delivery meets the unique needs of these students. Ethnic disparities in academic outcomes show patterns of privilege and should be alarming to tertiary institutions. If institutions are serious about achieving equitable outcomes for Māori and Pacific students, major institutional changes are necessary that ensure the unique needs of Māori and Pacific students are met.

Let's Move for Pacific Islander Communities: an Evidence-Based Intervention to Increase Physical Activity

Pacific Islander (PI) populations of Southern California experience high obesity and low physical activity levels. Given PI's rich cultural ties, efforts to increase physical activity using a community-tailored strategy may motivate members in a more sustainable manner. In this paper, we (1) detail the program adaptation methodology that was utilized to develop the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) Center's PI Let's Move Program, a culturally tailored program aimed to increase physical activity levels among members of PI organizations in Southern California, and (2) share the program's pilot evaluation results on individual and organizational changes. The WINCART Center applied the National Cancer Institute's program adaptation guidelines to tailor the evidence-based Instant Recess program to fit the needs of PIs. The end product, the PI Let's Move Program, was piloted in 2012 with eight PI organizations, reaching 106 PI adults. At baseline, 52 % of participants reported that they were not physically active, with the average number of days engaged in medium-intensity physical activity at 2.09 days/week. After the 2-month program, participants increased the number of days that they engaged in medium-intensity physical activity from 2.09 to 2.90 days/week. Post-pilot results found that 82 % of participants reported intentions to engage in physical activity for at least the next 6 months. At baseline, only one organization was currently implementing a physical activity program, and none had implemented an evidence-based physical activity program tailored for PIs. After the 2-month timeframe, despite varying levels of capacity, all eight organizations were able to successfully implement the program. In conclusion, results from our program provide evidence that disparity populations, such as PIs, can be successfully reached through programs that are culturally tailored to both individuals and their community organizations.

MINORITY UNDERGRADUATE NURSING STUDENT SUCCESS

BACKGROUND

Minority providers are more likely to practice in underserved areas with minority populations. Currently the representation of minorities in healthcare professions is less than that of the United States population. More research is needed to examine specific variables associated with educational success of minority students.

PURPOSE

The purpose of this study is to examine, and increase the understanding of, current factors that influence success among ethnic and minority nursing students.

METHODS

The revised Minority Student Nurse Questionnaire (MSNQ) was utilized for this study with a sample of 31 students from 2 entry-level nursing programs in the Midwest.

RESULTS

Minority students were slightly older than traditional college students and consisted of African-American Black, Native (American) Indian, Asian, Hispanic/Latino, and Hawaiian. Students reported multiple factors that influenced their higher education experience. Academic services and cultural organizations were available, free, but were used by less than half of the students. Several sources of financial assistance are important, including scholarships, federal subsidized and unsubsidized loans, and grants. Students most strongly disagreed with the statement that 'the number of minorities in this program is representative of the number of minorities overall.' Students felt that several services were supportive and helpful strategies for success.

CONCLUSION

Although progress has been made to improve success of minority students, numbers continue to lag between demographic population overall.

Family Model of Diabetes Education With a Pacific Islander Community

PURPOSE

The purpose of the study was to use a community-based participatory research approach to pilot-test a family model of diabetes education conducted in participants' homes with extended family members.

METHODS

The pilot test included 6 families (27 participants) who took part in a family model of diabetes self-management education (DSME) using an intervention-driven pre- and posttest design with the aim of improving glycemic control as measured by A1C. Questionnaires and additional biometric data were also collected. Researchers systematically documented elements of feasibility using participant observations and research field reports.

RESULTS

More than three-fourths (78%) of participants were retained in the study. Posttest results indicated a 5% reduction in A1C across all participants and a 7% reduction among those with type 2 diabetes. Feasibility of an in-home model with extended family members was documented, along with observations and recommendations for further DSME adaptations related to blood glucose monitoring, physical activity, nutrition, and medication adherence.

CONCLUSIONS

The information gained from this pilot helps to bridge the gap between knowledge of an evidence-based intervention and its actual implementation within a unique minority population with especially high rates of type 2 diabetes and significant health disparities. Building on the emerging literature of family models of DSME, this study shows that the family model delivered in the home had high acceptance and that the intervention was more accessible for this hard-to-reach population.

Quantitative analysis of a Māori and Pacific admission process on first-year health study

BACKGROUND

Universities should provide flexible and inclusive selection and admission policies to increase equity in access and outcomes for indigenous and ethnic minority students. This study investigates an equity-targeted admissions process, involving a Multiple Mini Interview and objective testing, advising Māori and Pacific students on their best starting point for academic success towards a career in medicine, nursing, health sciences and pharmacy.

METHODS

All Māori and Pacific Admission Scheme (MAPAS) interviewees enrolled in bridging/foundation or degree-level programmes at the University of Auckland were identified (2009 to 2012). Generalised linear regression models estimated the predicted effects of admission variables (e.g. MAPAS Maths Test; National Certificate in Educational Achievement (NCEA) Rank Score; Any 2 Sciences; Followed MAPAS Advice) on first year academic outcomes (i.e. Grade Point Average (GPA) and Passes All Courses) adjusting for MAPAS interview year, gender, ancestry and school decile.

RESULTS

368 First Year Tertiary (bridging/foundation or degree-level) and 242 First Year Bachelor (degree-level only) students were investigated. NCEA Rank Score (estimate 0.26, CI: 0.18-0.34, p< 0.0001); MAPAS Advice Followed (1.26, CI: 0.18-1.34, p = 0.0002); Exposure to Any 2 Sciences (0.651, CI: 0.15-1.15, p = 0.012); and MAPAS Mathematics Test (0.14, CI: 0.02-0.26, p = 0.0186) variables were strongly associated with an increase in First Year Tertiary GPA. The odds of passing all courses in First Year Tertiary study was 5.4 times higher for students who Followed MAPAS Advice (CI: 2.35-12.39; p< 0.0001) and 2.3 times higher with Exposure to Any Two Sciences (CI: 1.15-4.60; p = 0.0186). First Year Bachelor students who Followed MAPAS Advice had an average GPA that was 1.1 points higher for all eight (CI: 0.45-1.73; p = 0.0009) and Core 4 courses (CI: 0.60-2.04; p = 0.0004).

CONCLUSIONS

The MAPAS admissions process was strongly associated with positive academic outcomes in the first year of tertiary study. Universities should invest in a comprehensive admissions process that includes alternative entry pathways for indigenous and ethnic minority applicants.

Using cultural immersion as the platform for teaching Aboriginal and Torres Strait Islander health in an undergraduate medical curriculum

INTRODUCTION

In 2011 Bond University was looking for innovative ways to meet the professional standards and guidelines in Aboriginal and Torres Strait Islander health in its Bachelor of Medicine, Bachelor of Surgery (MBBS) curriculum. In 2012 Bond piloted a compulsory cultural immersion program for all first year students, which is now a usual part of the MBBS program.

METHODS

Three phases were included - establishing an Indigenous health group, determining the Aboriginal and Torres Strait Islander educational content based on the professional standards and developing nine educational sessions and resources - as well as significant administrative processes. The cultural immersion was piloted in 2012 with 92 first year medical students. Following refinements it was repeated in 2013 with 95 students and in 2014 with 94 students. A comprehensive evaluation process was undertaken that included a paper-based evaluation form using a five-point Likert scale, as well as a confidential talking circle evaluation. The response rate was 95.4% (n=271, pooled cohort). Data were entered separately into SPSS and annual reports were written to the Faculty. Descriptive statistics are reported alongside themed qualitative data.

RESULTS

The three combined student evaluation results were extremely positive. Students (n=271) strongly agreed that the workshop was well organised (M=4.3), that the facilitators contributed very positively to their experience (M=4.3), and that they were very satisfied overall with the activity (M=4.2). They agreed that the eight overall objectives had been well met (M=3.9-4.3). The nine sessions were highly evaluated with mean ratings of between 3.9 and 4.8. The 'best thing' about the immersion identified by more than half of the students was overwhelmingly (n=140) the Storytelling session, followed by bonding with the cohort, the Torres Strait Islander session and learning more about culture. The item identified as needing most improvement was the food (n=87), followed by the accommodation (n=65).

CONCLUSIONS

The use of immersion in the early part of a cultural awareness program for medical students provides an extremely valuable platform from which to launch more detailed information about the history of Aboriginal and Torres Strait Islander Australia and its impact on the current health status of Aboriginal and Torres Strait Islander Australians. Doing this in a safe, supportive cross-cultural environment with highly skilled facilitators is essential. Key to success is strong leadership, commitment and support from Faculty level, a structured educational program and educating all staff and students about its importance throughout the journey.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

INTRODUCTION

There is a 70% higher age-adjusted incidence of heart failure (HF) among Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths as among non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community health care to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing.

METHODS

This study was conducted in two phases and utilised a mixed-methods approach (qualitative and quantitative). Phase 1 used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. An HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources, and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made.

RESULTS

Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this, and members of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. Phase 2: Five Aboriginal participants, mean age 61.6±10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0±6.7% to 58.0±9.7%, a 20.8% increase, and results of the self-care index indicated that the biggest change was in patient confidence for self-care, with a 95% increase in confidence score (46.7±16.0 to 91.1±11.5). Changes in management and maintenance scores varied between patients.

CONCLUSIONS

By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Mini-med school for Aboriginal youth: experiential science outreach to tackle systemic barriers

INTRODUCTION

Addressing systemic barriers experienced by low-income and minority students to accessing medical school, the University of Calgary's Cumming School of Medicine has spearheaded a year-round, mini-med school outreach initiative for Aboriginal students.

METHOD

Junior and senior high school youth generally attend the half-day program in classes or camps of 15-25, breaking into small groups for multisession activities. Undergraduate medical education students mentor the youth in stations offering experiential lessons in physical examination, reading x-rays, and anatomy. All resources from the medical school are offered in-kind, including a pizza lunch at midday, whereas community partners organize transportation for the attendees.

RESULTS

Opening the medical school and its resources to the community offers great benefits to resource-constrained schools often limited in terms of science education resources. The model is also an effort to address challenges among the medical professions around attracting and retaining students from underserved populations.

CONCLUSION

The prospect of increasing admission rates and successful completion of medical education among students from marginalized communities poses a real, though difficult-to-measure, possibility of increasing the workforce most likely to return to and work in such challenging contexts. A mini-medical school for Aboriginal youth highlights mutual, long-term benefit for diverse partners, encouraging medical educators and community-based science educators to explore the possibilities for deepening partnerships in their own regions.

Challenges faced by Indigenous nursing students and strategies that aided their progress in the course: A descriptive study

Marked improvements in Indigenous health can be achieved by increasing the participation of Indigenous people in the health professions. Currently in Australia the participation by Indigenous people in the health professions is low and the Indigenous people of Australia continue to have poor health outcomes. This qualitative study utilised interviews with 22 Indigenous students enrolled in undergraduate nursing degrees across Australia, to explore the challenges they faced and uncover the strategies they had found helpful to their progress in the course. The findings indicate that students are challenged by financial hardship, staff insensitivity to cultural issues, discrimination, lack of Indigenous mentors, poor study skills, lack of adequate educational preparation, lack of resources, and ongoing family commitments. Strategies identified as particularly helpful to tenure within the course include specific Indigenous support units, adequate financial support, interested academics, Aboriginal Tertiary Assistance Scheme (ATAS) tutors, support from family and friends, and support from other students.

Cultural diversity: A challenge for community nurses

Cultural diversity is a challenge for community nurses and can present many difficulties in the provision of quality nursing care and in achieving optimal health outcomes. In this paper seven enabling principles are identified and their application to diverse groups discussed. These include: willingness to recognize expert family skills and knowledge, acknowledging own and other nurses' strengths and weakness, taking time to establish rapport and acceptance, assessing influences on health and health care, providing care that is culturally appropriate, developing cultural competent practice and advocating for CLD appropriate resources and expertise. The aim of this paper is to assist community nurses to provide nursing care congruent with the many lifeway practices encountered in the community. Diverse cultural groups with distinguishing dominant characteristics of ethnic orientation, aboriginality, and disability are selected as examples to demonstrate the application of the principles.

Buckle up safely (shoalhaven): a process and impact evaluation of a pragmatic, multifaceted preschool-based pilot program to increase correct use of age-appropriate child restraints

OBJECTIVE

To conduct a process and impact evaluation of a multifaceted education-based pilot program targeting correct use of age-appropriate restraints in a regional setting with a high proportion of Aboriginal and Torres Strait Islander families.

METHODS

The program was delivered in 2010 in 3 early learning centers where 31 percent of the children were of Aboriginal and Torres Strait Islander descent. Each component of the program was assessed for message consistency and uptake. To measure program effectiveness, participating children were matched 1:1 by age, language spoken at home, and annual household income with 71 children from the control arm of a contemporaneous trial. The outcome measure in the control and program centers (a 4-category ordinal scale of restraint use) was compared using ordinal logistic regression accounting for age of the parent.

RESULTS

Process evaluation found that though program components were delivered with a consistency of message, uptake was affected by turnover of all staff at one center and by parents experiencing difficulty in paying for subsidized restraints at each of the centers. Impact evaluation found that children from the centers receiving the program had nearly twice the odds of being in a better restraint category than children matched from the control group (adjusted odds ratio [ORadj] = 2.06, 95% confidence interval [CI], 1.09-3.90).

CONCLUSIONS

This was a pragmatic study reflecting the real-life issues of implementing a program in preschools where 57 percent of families had a low income and turnover of staff was high. Despite these issues, impact evaluation showed that the integrated educational program showed promise in increasing correct use of age-appropriate restraints. The findings from this pilot study support the use of an integrated educational program that includes access to subsidized restraints to promote best practice child restraint use among communities that include a high proportion of Aboriginal and Torres Strait Islander families in New South Wales. Future trials in similar settings should consider offering more support in centers with high turnover of staff and offering alternative methods of payment when families experience financial difficulties in purchasing the subsidized restraints. If proven in larger trials, this approach could reduce death and injuries in child passengers in this vulnerable group.

Barriers in education of indigenous nursing students: a literature review

The poor health status of indigenous people has been identified internationally as a critical issue. It is now commonly accepted that the ability to address this concern is hindered, in part, by the disproportionately low number of indigenous health professionals, including nurses. This paper reports the findings of a review of literature that aimed to identify key barriers in the education of the indigenous undergraduate nursing students in the tertiary sector, to identify strategies to overcome these, and discuss these elements within the New Zealand context. A number of health-related databases were searched and a total of 16 peer-reviewed articles from Canada, U.S.A., Australia and New Zealand were reviewed. Key barriers to recruitment and retention and strategies to overcome these are presented. Barriers to recruitment included: academic unpreparedness; poor understanding of cultural needs; and conflicting obligations, and financial constraints. Barriers to retention included lack of cultural and academic support, family obligations and financial hardship. Strategies to address recruitment barriers included: addressing pre-entry education requirements; targeted promotion of nursing programmes; indigenous role models in the recruitment process; and streamlining enrolment processes to make programmes attractive and attainable for indigenous students. Strategies to address retention barriers included: cultural relevance within the curriculum; identifying and supporting cultural needs of indigenous students with active participation of indigenous staff; engaging communities and funding support. The crucial development of partnerships between academic institutes and indigenous communities to ensure the provision of a culturally safe, supportive environment for the students was stressed. In New Zealand, while government-level policy exists to promote the success of MBori nursing students, the translation of what is known about the recruitment and retention of indigenous students is an area for development.

Pacific students undertaking the first year of health sciences at the University of Otago, and factors associated with academic performance

AIM

To describe Pacific students in the first year of health sciences at tertiary level, their academic performance, and factors associated with academic outcomes.

METHOD

Routinely collected data for students who enrolled in the Health Sciences First Year (HSFY) programme at the University of Otago between 2007 and 2011, including their school National Certificate in Educational Achievement (NCEA) results were obtained in anonymous form. Descriptive statistics were calculated and regression analyses were undertaken using SAS v9.2 software.

RESULTS

A small but increasing number of Pacific students are enrolling in health sciences at tertiary level. Pacific students had poorer performance compared to non-Pacific students in both NCEA and the HSFY programme. Factors associated with academic performance were gender, NCEA results, school decile, accommodation type, ethnicity, international status and disability.

CONCLUSION

Pacific students are under-represented in health sciences and would benefit from better preparation from school. Pacific solutions are required to improve academic outcomes over and above mainstream policy solutions. Tertiary institutions need to engage prospective students earlier to ensure they are well informed of requirements, and are appropriately prepared for study at the tertiary level.

An oral health literacy intervention for Indigenous adults in a rural setting in Australia

BACKGROUND

Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy.

METHODS/DESIGN

This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrollment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism.

DISCUSSION

This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

Aboriginal women and Asian men: a maritime history of color in white Australia

In 1901, Broome—a port town on the northwest edge of the Australian continent—was one of the principal and most lucrative industrial pearling centers in the world and entirely dependent on Asian indentured labor. Relations between Asian crews and local Aboriginal people were strong, at a time when the project of White Australia was being pursued with vigorous, often fanatical dedication across the newly federated continent. It was the policing of Aboriginal women, specifically their relations with Asian men, that became the focus of efforts by authorities and missionaries to uphold and defend their commitment to the White Australia policy. This article examines the historical experience of Aboriginal women in the pearling industry of northwest Australia and the story of Asian-Aboriginal cohabitation in the face of oppressive laws and regulations. It then explores the meaning of “color” in contemporary Broome for the descendants of this mixed heritage today.

Exposing the hidden curriculum influencing medical education on the health of Indigenous people in Australia and New Zealand: the role of the Critical Reflection Tool

The disparity in health status between Indigenous and non-Indigenous people in Australia and New Zealand is widely known, and efforts to address this through medical education are evidenced by initiatives such as the Committee of Deans of Australian Medical Schools' Indigenous Health Curriculum Framework. These efforts have focused primarily on formal curriculum reform. In this article, the authors discuss the role of the hidden curriculum in influencing the teaching and learning of Indigenous health (i.e., the health of Indigenous people) during medical training and suggest that in order to achieve significant changes in learning outcomes, there needs to be better alignment of the formal and hidden curriculum. They describe the Critical Reflection Tool as a potential resource through which educators might begin to identify the dimensions of their institution's hidden curricula. If used effectively, the process may guide institutions to better equip medical school graduates with the training necessary to advance changes in Indigenous health.

Effective nutrition education for Aboriginal Australians: lessons from a diabetes cooking course

OBJECTIVES

To examine the experiences of Aboriginal Australians with or at risk of diabetes who attended urban community cooking courses in 2002-2007; and to develop recommendations for increasing the uptake and effectiveness of nutrition education in Aboriginal communities.

METHODS

Descriptive qualitative approach using semistructured interviews with 23 Aboriginal course participants aged 19-72. Verbatim transcripts were coded using NVivo 7 software, and qualitative analysis was undertaken.

RESULTS

Engagement and learning were increased by emphasizing the social aspects of the program, holding the course in a familiar Aboriginal community-controlled health setting and using small group learning with Aboriginal peers. Partnership with a vocational training institute provided teaching expertise, but there was conflict between vocational and health promotion objectives.

CONCLUSIONS AND IMPLICATIONS

Nutrition programs for Aboriginal Australians should be social, flexible, and held in accessible, culturally appropriate settings and focus on healthful cooking techniques using simple, affordable ingredients.

Decentralization, democratization, and health: the Philippine experiment

In 1991, the Philippines joined a growing list of countries that reformed health planning through decentralization. Reformers viewed decentralization as a tool that would solve multiple problems, leading to more meaningful democracy and more effective health planning. Today, nearly two decades after the passage of decentralization legislation, questions about the effectiveness of the reforms persist. Inadequate financing, inequity, and a lack of meaningful participation remain challenges, in many ways mirroring broader weaknesses of Philippine democracy. These concerns pose questions regarding the nature of contemporary decentralization, democratization, and health planning and whether these three strategies are indeed mutually enforcing.

Export quality: representing Fijian bodies and the economy of war

Fijian bodies have become a valuable commodity in the economy of war. Remittances from workers overseas are Fiji's largest income – exceeding that of tourism and sugar export. This essay examines historical and contemporary representations of the black male body that perpetuate the exploitation of Fijians by inscribing the Fijian male body as warrior, criminal and protector. Taking a multidisciplinary approach informed by sociology, cultural theory, Pacific studies, visual culture, feminist and post-colonial theory, my practice is the vehicle through which I address issues of neocolonial commodification of Fijian bodies. Through an analysis of my own staged photographs and vernacular images taken by Fijians working for private security military companies and British and US armies, I hope to challenge audiences to consider their own perceptions of Fijian agency and subjectivity. By theorising the politicisation of the black body and interrogating colonial representations of blackness, I argue that we can begin to create links between the historical and contemporary exploitation of Fijians and that at the essence of both is an underlying racial hierarchy and economic requirement for cheap and, arguably, expendable labour.

Managing a massacre: savagery, civility, and gender in Moro Province in the wake of Bud Dajo

This article examines the delicate ideological maneuverings that shaped American colonial constructions of savagery, civility, and gender in the wake of the Bud Dajo massacre in the Philippines's Muslim south in 1906. It looks particularly at shifting notions of femininity and masculinity as these related to episodes of violence and colonial control. The article concludes that, while the Bud Dajo massacre was a terrible black mark on the American military's record in Mindanao and Sulu, colonial officials ultimately used the event to positively affirm existing discourses of power and justification, which helped to sustain and guide military rule in the Muslim south for another seven years.

How do newly diagnosed patients with type 2 diabetes in the Waikato get their diabetes education?

INTRODUCTION

Education is accepted as the mainstay of management for people with diabetes. However, there are few population-based studies describing what education has been delivered from the patient's perspective.

AIM

To ascertain the sources of education for patients with newly diagnosed type 2 diabetes; what education was received and what were the patients' views of group education. Delivery of education to Maori was compared with non-Maori.

METHODS

A cross-sectional survey of patients identified from the Waikato Regional Diabetes Service database. Patients identified in one calendar year, having a diagnosis of type 2 diabetes and being aged between 20 and 89 years were included in the survey. Patients were sent a four-page questionnaire. Nonresponders were followed up by telephone.

RESULTS

333/667 patients (50%) responded. The principal source of education for Waikato patients was general practice, from the general practitioner and/or the practice nurse. Ninety-three percent of patients reported that they had received some education about diabetes at the time of diagnosis. There was no difference between Maori and non-Maori in the reported levels of diabetes education received, but the patient perceived knowledge score was significantly lower for Maori in all aspects studied.

DISCUSSION

The overall impression was that patients were receiving appropriate information about diabetes, but there does appear to be room for improvement in some areas, particularly the importance of blood pressure and lipid control. We believe that further research on the educational needs of Maori and ethnic minorities is needed.

A food store intervention trial improves caregiver psychosocial factors and children's dietary intake in Hawaii

Diet-related chronic diseases are at epidemic levels in low-income ethnic minority populations. The purpose of this study is to decrease risk for obesity in children by modifying the food environment and conducting point-of-purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low-income communities with a preponderance of Native Hawaiians and Pacific Islanders. We implemented an intervention trial over a 9-11-month period in five food stores in two low-income multiethnic communities in Hawaii, targeting both children and their adult caregivers. The Healthy Foods Hawaii (HFH) intervention consisted of an environmental component to increase store stocking of nutritious foods, point-of-purchase promotions, interactive sessions, and involved local producers and distributors. We evaluated the impact of the program on 116 child-caregiver dyads, sampled from two intervention and two comparison areas before and after intervention implementation. Program impacts were evaluated using multivariable linear regression. The HFH program had a significant impact on caregiver knowledge and the perception that healthy foods are convenient. Intervention children significantly increased their Healthy Eating Index (HEI) score for servings of grains, their total consumption of water, and showed an average 8.5 point (out of 90 total, eliminating the 10 points for variety, giving a 9.4% increase) increase in overall HEI score. A food store intervention was effective in improving healthy food knowledge and perception that healthy foods are convenient among caregivers, and increased the consumption of several targeted healthy foods by their children. Greater intensity, sustained food system change, and further targeting for children are needed to show greater and sustained change in food-related behaviors in low-income Native Hawaiian and Pacific Islander communities.

Tuakana-Teina relationship and leadership in ancient Mangaia and Aotearoa

The relationship between tuakana and teina (the older and younger sibling or cousin of same sex) is the tumu (foundation, origin, cause) of rank in eastern Polynesia. By examining historical documents from selected island societies, namely, Mangaia and Aotearoa, we can understand the dynamics of this relationship as part of their world-view. Normally tuakana and teina had close, cooperative, mutually respectful and loyal relationships; the teina supporting their elder. Sometimes, however, the moral balance between them was affected either by one of them acting inappropriately towards the other, or by hostile acts from others. To remedy these threats to social cohesion, various strategies were adopted, including peace-making, flight or spatial separation, or fighting. Stories about this relationship continue to serve as the tumu for today's younger generations.

"Two colours, one people?": the paradoxes of the multiracial union Calédonienne in the commune of Koné (New Caledonia, 1951-1977)

Between the 1950s and the 1970s, New Caledonian politics were dominated by one major party, the Union Calédonienne (UC), supported by the vast majority of Kanak voters and a crucial minority of European voters. In retrospect, the multicultural project of the UC under the rubric 'two colours, one people' can seem quite surprising, as it was elaborated less than ten years after the end of a particularly oppressive colonial era and three decades before the emergence of radical Kanak demands for decolonisation. This paper analyses the ambiguous relationships between the UC and New Caledonia's colonial heritage through a micro-historical sociology of the party in the rural commune of Koné (northwest coast) that draws on both archival research and interviews. With regard to both colonial and socio-economic cleavages, the paper retraces the individual and collective trajectories of UC militants and elected members of the mairie (municipal council), to gain a better understanding of the local electoral success of the party. On the scale of Koné, the UC relied in practice on a complex articulation between diverse social logics of political affiliation: across colonial frontiers, within and among Kanak communities, 'little settlers' (petits colons), merchants, mining workers, and 'white' (or not so 'white') local populations.