Community-based action research to improve college success among Native Hawaiian and other underserved students

Background: Native Hawaiians, representing 25% of Hawai‘i's population, suffer socioeconomic (SES) and health strains as evidenced by over-representation in low-wage jobs without health insurance and higher prevalence of chronic disease compared to Hawai‘i's other ethnic groups. Native Hawaiians are more likely to attend community colleges than 4-year colleges, but have high dropout rates. Objective: To describe a culturally relevant, community-based action research approach to build a program to keep Hawaiians in college to advance career options and improve long-term health and SES outcomes. Methods: Culturally relevant approaches that depended on participation from a variety of community partners were used to evaluate needs and design interventions. Results: The Pathway Out of Poverty Program uses Hawaiian values and traditions of healthy living to lead students through a nursing pathway from Nurse Aide (NA) to Licensed Practical Nurse (LPN) to Registered Nurse (RN), with inherent increases in wage-earning potential. In the first 3.5 years, 150 students enrolled in NA training, and 135 students (90%) graduated and were certified. Of the 135, 77 (57%) transitioned to higher education and 79% transitioned to jobs that offered health insurance (20% were in both groups). Of the 77 entering higher education, 33 (43%) aimed for a degree in nursing. Students expressed growing interest in health promotion for themselves, family members, and others. Conclusion: Community partners were key to developing a successful community college-based Pathway Programs to help marginalized and other underrepresented students move from low-wage to living-wage jobs and improve their long-term health outcomes.