Native Hawaiian Homestead residents' perceptions of cultural safety in community-based health research

Ph.D. University of Hawaii at Manoa 2014.Includes bibliographical references.Background Native Hawaiian communities have consistently expressed distrust and raised concerns about their participation in research programs that disregard the cultural norms. Thus, they are reluctant to participate in conventional research. Objectives The purpose of this study was to describe Native Hawaiian Homestead residents' perceptions of "cultural safety" and assess perceptions that may affect this group's participation in research. Methods Qualitative data were collected from three purposively selected Hawaiian Homestead communities, Wai'anae, Papakolea, and Waimanalo (N = 27 adults). Three community cofacilitators were recruited and trained in qualitative research methods. Five focus groups and five key informant interviews were conducted. All participants completed a social-demographic survey. Data were audio-recorded, transcribed, and coded. Data analysis involved a content analysis and co-analysis with the community co-facilitators. Results Six major themes emerged, including that upstream factors influence perceptions of cultural safety, that attention to the ethical values of Hawaiian culture and Homestead communities promotes cultural safety, that culturally safe research reflects "culture" as multi-dimensional, that community empowerment is intricately linked to cultural safety, that cultural safety is relationally-based, and that safety is wholistic with systemic and community factors influencing personal perceptions. Conclusions Native Hawaiian Homestead residents were skeptical about conventionally conducted research that disrespected their indigenous culture and that ignored public engagement. Therefore, cultural safety is a relevant concept for promoting the active engagement of residents in research that honors the cultural preferences. The cultural safety framework also facilitates the dignity, justice, and wellbeing of Hawaiian Homestead residents. Implications Ethically designed and culturally safe research provides the right evidence and direction for appropriate and locally-fit solutions. Social welfare and health research interventions will be effectively implemented in Native Hawaiian communities if they are culturally safe. Cultural safety training will be useful for building the capacity of policy-makers, researchers, and professionals. Researchers will pay attention to cultural safety aspects, be respectful and sensitive to the culture. Agencies such as universities, hospitals, and schools will develop culturally safe policies and design unique programs that meet the need of indigenous peoples, including Native Hawaiians. They can recognize their responsibilities of readdressing the "unsafe" policies and practices by redistributing the power and resources