Health Access for Native Hawaiians and Pacific Islanders: Latent Determinants of Mental Health Care Service Utilization

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 higher 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 mental health conditions and mental health disparities that are prevalent in this community (e.g., depression, anxiety, alcohol use disorder, and tobacco use), particularly following the global COVID-19 pandemic. The overarching goal of this research is to improve and broaden understanding of novel multi-level health determinants causing low mental health care service utilization rates of NHPIs, a presently understudied health disparity for Native Hawaiians and other Pacific Islanders in the U.S. Design: A closed access, cross-sectional Internet survey was used to collect data. Participants were recruited with announcements distributed nationwide via email to NHPI organizations, associations, and networks across the United States and social media. The sample included 395 NHPI adults aged 18 and older. Analysis: Latent profile analysis (LPA) were conducted using Mplus 8 statistical software to examine whether different conceptually meaningful profiles of NHPI Islanders emerge based on hypothesized health determinants measuring Symptom Distress (Perceived Health Status, Depression/Anxiety, and Perceived Stress), Protective Factors (Pacific Cultural Efficacy, Religious Centrality and Embeddedness, Pacific Connectedness and Belonging, and Perceived Societal Wellbeing) and Health Attitudes (Medical Mistrust and Service Provider Preferences [i.e., Traditional/Native Healer vs Medical Doctor/Nurse]) while accounting for demographic covariates (e.g., education, income, and insurance status). Results supported a four-profile model solution, where four distinct groups (named “Very Low Symptomatic,” “Low Symptomatic,” “Moderate Symptomatic,” and “High Symptomatic”) of participants demonstrated varying levels of symptom distress, endorsement of protective factors, and health attitudes. Furthermore, planned mental health care utilization was analyzed as an outcome variable, demonstrating varying levels of planned mental health service utilization across the four profiles. Significance: Findings may inform public policy and healthcare professionals about how to meaningfully engage NHPI communities in culturally competent mental health care services.