Chuukese community experiences of racial discrimination and other barriers to healthcare: Perspectives from community members and providers

Abstract

Racial discrimination is a critical barrier to quality healthcare for many ethnic/racial groups in the United States (US). Chuukese are a rapidly growing, yet understudied, Pacific Islander group in the US. Research suggests that Pacific Islanders in the US have a high burden of chronic and infectious diseases, but underutilize preventive health services. The purpose of this study was to explore the Chuukese community’s experiences with healthcare, particularly reports of racial discrimination. In-depth interviews were conducted with nine Chuukese community participants and eight healthcare providers serving this community in Hawai‘i. Purposive and referral sampling were used to identify participants. Data were analyzed using framework analysis. Barriers to healthcare utilization included inadequate healthcare coverage and lack of trust between providers and patients due to differences in language and culture. All participants shared examples of racial discrimination experienced by Chuukese individuals both in and out of the healthcare system. Many participants revealed that racial discrimination was often difficult to discuss openly, and that it negatively impacted their health by increasing stress and mistrust and decreasing access to needed services. Participants recommended concrete actions to broach conversations regarding racial discrimination, including creating a neutral agency to address complaints and asking about patients' family and community experience with discrimination. Providers shared how they modified their care to better serve Chuukese patients by recognizing and building on community assets, such as strong religious and family connections. These findings are relevant to providers working to address racial discrimination and improving healthcare for underrepresented immigrant ethnic groups.