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

项目摘要/摘要 背景：18岁及以上的夏威夷原住民和其他太平洋岛民(NHPI)成年人的比例很高(37.4%) 在过去的一年里没有看过医生。这是所有种族群体中比例最高的。此外，大约 每八个NHPI成年人中就有一个(12%)没有保险，这一比率明显低于白人。联邦报告历来举步维艰 以获取能够解释这些现象的数据。因此，NHPI在健康中代表不充分和不完全 统计数据显示，与其他种族和少数民族群体相比，他们以较低的费率获得医疗服务，并以较低的费率获得保险。 这对该社区中普遍存在的不良健康状况和差异的持续存在具有影响(例如， 心血管疾病、高血压、糖尿病、心脏病、癌症等)。目标：本研究的首要目标 是改善和拓宽我们对导致(1)低健康服务的新的多层次健康决定因素的理解 卫生保健服务的使用率和(2)医疗保险覆盖率低，目前对卫生保健服务的研究不足 夏威夷原住民和其他太平洋岛民在美国设计中的差异：封闭接入、跨部门互联网 调查将被用来收集数据。参与者将被招募，通知将通过电子邮件分发到全国 全美各地的NHPI组织、协会和网络以及社交媒体。建议的样本量为300。 NHPI 18岁及以上的成年人。分析：潜伏期分析(LPA)将使用Mplus 8统计软件进行 检查是否根据假设的水平出现不同概念上有意义的NHPI岛民概况 个人(抑郁、焦虑和感觉到的压力)，人际(医疗不信任和种族歧视)， 社区(文化效能和太平洋的连通性和归属感)和社会层面(宗教中心和 社会幸福感)健康决定因素，同时考虑人口统计协变量。然后我们将测试一下 由此产生的概况具有不同的医疗接入率(医疗服务利用率和保险覆盖范围)。LPA符合 这项研究的目的是确定潜在的个人、人际、 社区和社会层面的卫生保健可获得性决定因素，并检查其概况是否不同 卫生服务利用率和保险覆盖率。潜在轮廓分析允许对测量进行估计 错误，以提高估计的准确性。意义：调查结果将向公共政策和医疗保健专业人员通报 这在卫生研究中的代表性严重不足，以消除过低的医疗保健利用率和 NHPI的保险覆盖率较低。这一结果可能有助于培养文化能力 在健康服务和行为健康研究中对这一代表性和服务不足的社区进行干预。

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.