Health Access for Native Hawaiians and Pacific Islanders: Determinants of Health Service Utilization and Insurance Coverage

夏威夷原住民和太平洋岛民的健康获取：健康服务利用和保险覆盖范围的决定因素

• 批准号: 10682335
• 负责人: Steven Sasa Marsiglia
• 金额: $ 4.2万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-07 至 2024-04-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10682335
• 关键词: Accounting; Address; Adult; Analysis of Variance; Anxiety; Awareness; Cardiovascular Diseases; Characteristics; Communities; Computer software; Data; Data Collection; Data Set; Development; Diabetes Mellitus; Dimensions; Disparity; Disparity population; Electronic Mail; Ethnic Population; Geography; Goals; Health; Health Disparities Research; Health Insurance; Health Professional; Health Services; Health Services Accessibility; Health Status; Healthcare; Heart Diseases; Hypertension; Income; Individual; Influentials; Insurance Coverage; Internet; Intervention; Literature; Malignant Neoplasms; Measurement; Measures; Medical; Mental Depression; Methods; Modeling; National Health Interview Survey; National Institute on Minority Health and Health Disparities; Native Hawaiian; Native Hawaiian or Other Pacific Islander; Nature; Outcome; Participant; Personal Satisfaction; Population; Provider; Public Health; Public Policy; Regression Analysis; Religion; Reporting; Research; Samoan; Sample Size; Subgroup; Surveys; Testing; Underrepresented Populations; Uninsured; United States; United States National Center for Health Statistics; access disparities; aged; behavioral health; cultural competence; design; ethnic minority population; health care availability; health care service utilization; health data; health determinants; health service use; improved; innovation; insight; neglect; novel; perceived stress; preference; racial discrimination; racial minority population; racial population; recruit; service providers; social culture; social media; statistics; theories; underserved community

PROJECT SUMMARY/ABSTRACT Background: A high percentage of Native Hawaiian and other Pacific Islander (NHPI) adults (37.4%) aged 18 and older did not see a doctor in the past year. This is the highest percentage among all racial groups. Furthermore, approximately one in eight NHPI adults (12%) are uninsured, a rate that is markedly lower than Whites. Federal reports historically struggle to capture data that could explain these phenomena. Hence, NHPI are insufficiently and incompletely represented in health statistics, access health services at lower rates, and are insured at lower rates than other racial and ethnic minority groups. This has implications for perpetuating adverse health conditions and disparities that are prevalent in this community (e.g., cardiovascular disease, hypertension, diabetes, heart disease, cancer, etc.). Objective: The overarching goal of this research is to improve and broaden our understanding of novel multi-level health determinants causing (1) low health service utilization rates and (2) low health insurance coverage rates of NHPIs, which are presently understudied health access disparities for Native Hawaiians and other Pacific Islanders in the U.S. Design: A closed access, cross-sectional Internet survey will be used to collect data. Participants will be recruited with announcements distributed nationwide via email to NHPI organizations, associations, and networks across the United States and social media. The proposed sample size is 300 NHPI adults aged 18 and older. Analysis: Latent profile analysis (LPA) will be conducted using Mplus 8 statistical software to examine whether different conceptually meaningful profiles of NHPI Islanders emerge based on levels of hypothesized individual (Depression, Anxiety and Perceived Stress), interpersonal (Medical Mistrust and Racial Discrimination), community (Cultural Efficacy and Pacific Connectedness and Belonging) and societal-levels (Religious Centrality and Perceived Societal Wellbeing) health determinants while accounting for demographic covariates. We will then test whether the resulting profiles had differential healthcare access rates (health service utilization and insurance coverage). LPA fits the purpose of this study, which is to determine distinct configurations (i.e., profiles) of potential individual, interpersonal, community and societal-level health determinants of healthcare access and to examine whether profiles differed in their health service utilization rates and insurance coverage rates. Latent profile analysis allows for the estimation of measurement error to improve accuracy of estimates. Significance: Findings will inform public policy and healthcare professionals about this severely underrepresented population in health research to eliminate excessively low levels of healthcare utilization and low insurance coverage rates among NHPI. The results could contribute to the development of culturally competent interventions for this underrepresented and underserved community in health services and behavioral health research.

项目总结/文摘