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