What does values have to do with it? Examining the healthcare capacity building efforts of Native Hawaiian primary care professionals in rural, underserved communities

Introduction. A shortage of Native Hawaiian healthcare professionals exists in Hawai`i medically underserved communities. Contributing to this shortage is the disproportionately low enrollment of Native Hawaiians in primary healthcare education. The Native Hawaiian Health Scholarship Program (NHHSP) of Papa Ola Lokahi addresses the shortage by providing scholarships to Native Hawaiians in designated primary health care professionals and then facilitating their employment in Hawai`i rural communities to perform their service obligation. Cultural values are incorporated into screening and training components of the NHHSP.

Methods. The NHHSP uses a values-based assessment to select scholarship awardees. by In May 2006, we surveyed 104 scholars who were performing or had completed their service obligation as primary care providers. The 54 returned surveys were analyzed to see if scholars for whom Hawaiian values were more important made greater contributions in their rural sites.

Conclusion. NHHSP scholars are making significant contributions to develop the capacity of community healthcare systems. As a health workforce, 73% of clinicians who completed their service remained in their rural sites an average of 2.8 years (range 4 months to 8 years), exceeding the retention rate for National Health Service Corps scholarship and loan repayment programs of 21% and 57%, respectively. Respondents held significant leadership roles and active memberships in Native Hawaiian communities, and 85% had developed 3 to 4 Native Hawaiian community programs during their service. Those scholars who rated themselves higher on the community-identified values held significantly more leadership positions and had helped develop behavioral and cultural programs in their sites. To our knowledge, this is the first study conducted to understand how community-identified values of healthcare providers contribute to capacity-building efforts in underserved communities. What this study has done is suggest that future studies conducted on the health of Native Hawaiians, as well as other vulnerable populations, warrant novel ways of understanding how primary care providers contribute to the elimination of health disparities.