Native Hawaiians are more likely than members of Hawai'i's other ethnic groups to be diagnosed with late- stage cancer and to have low cancer screening rates. About 23,000 Native Hawaiians statewide reside in Native Hawaiian Homestead Communities, which offer affordable housing and agricultural land to individuals with 50% or greater Hawaiian blood quantum. Although high blood quantum may serve as a proxy for other variables (e.g., low socio-economic status, low prevalence of health insurance), it has been associated with increased risk of morbidity. Little is known about Homestead residents, but we expect lower prevalence of insurance and lower participation in cancer screening among Homestead dwellers compared to Hawaiians in the general population. We request funds to identify barriers and facilitators to cancer screening in the Waimanalo Native Hawaiian Homestead community on O'ahu, and to gauge receptivity to interventions found successful in other Native Hawaiian communities. Through partnership with the University of Hawaii medical school and the Waimanalo Homestead, interviews will be conducted by student-community member teams. Houses will be selected based on protocol informed by science and Hawaiian tradition. Using the quota method for selecting whom to interview within a household and estimating a 85% participation rate, we aim for 70 interviews in each of 4 categories -- females age 25-50, females older than 50, males age 25-50, and males older than 50. Guided by the Anderson and Aday model of health care utilization, survey items will tap characteristics of the population (e.g., knowledge, attitudes, insurance status) and characteristics of existing services (e.g., access, subsidized screening, cultural targeting) to assess barriers and facilitators to recommended cancer screening. Survey items also will tap receptivity of interventions shown to increase cancer screening in other Hawaiian communities, including a family cancer screening day, small group cancer education, and individual cancer education. Assessment data will be reviewed in 4 Homestead-based focus groups, with the purpose of designing an intervention needed and wanted by the Waimanalo Homestead. This intervention will be tested in future research that involves the Waimanalo Homestead and other Homestead communities in the state. ? ? ? ?
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