BackgroundPotentially preventable hospitalizations (PPH) for heart failure (HF) and diabetes mellitus (DM) cost the United States over $14 billion annually. Studies about PPH typically lack patient perspectives, especially across diverse racial/ethnic groups with known PPH health disparities.MethodsEnglish-speaking individuals with a HF or DM-related PPH (n = 90) at the largest hospital in Hawai‘i completed an in-person interview, including open-ended questions on precipitating factors to their PPH. Using the framework approach, two independent coders identified patient-reported factors and pathways to their PPH.ResultsSeventy-two percent of respondents were under 65 years, 30 % were female, 90 % had health insurance, and 66 % had previously been hospitalized for the same problem. Patients’ stories identified immediate, precipitating, and underlying reasons for the admission. Underlying background factors were critical to understanding why patients had the acute problems necessitating their hospitalizations. Six, non-exclusive, underlying factors included: extreme social vulnerability (e.g., homeless, poverty, no social support, reported by 54 % of respondents); health system interaction issues (e.g., poor communication with providers, 44 %); limited health-related knowledge (42 %); behavioral health issues (e.g., substance abuse, mental illness, 36 %); denial of illness (27 %); and practical problems (e.g., too busy, 6 %). From these findings, we developed a model to understand an individual’s pathways to a PPH through immediate, precipitating, and underlying factors, which could help identify potential intervention foci. We demonstrate the model’s utility using five examples.ConclusionsIn a young, predominately insured population, factors well outside the traditional purview of the hospital, or even clinical medicine, critically influenced many PPH. Patient perspectives were vital to understanding this issue. Innovative partnerships and policies should address these issues, including linkages to social services and behavioral health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1511-6) contains supplementary material, which is available to authorized users.

BackgroundApproximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed.ObjectiveThe goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension.MethodsIn-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors.ResultsA number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider.ConclusionsInformation from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider.

Background: Native Hawaiians (NHs) suffer disproportionately from cardiovascular disease morbidity and mortality. Objective: To test a narrative intervention of patient stories to support heart disease self-management in NHs. Method: Six NH storyteller videos were developed with community feedback following established methods. The NH participants with heart failure (N = 35) were recruited from a major medical center in Hawai‘i. Participants completed demographic questionnaires, watched videos via iPad, and described experiences. Follow-up was 4 weeks later. Results: Mean participant age was 57.0 years (standard deviation [SD]:13.0) and 31% (11) were female. On a scale of 1 (worst) to 4 (best), respondents rated the videos 3.7 (SD: 0.5) in relevance for helping them manage their heart disease and 3.6 (SD: 0.5) in their experience using these videos. When asked what they liked best, the most common response was that they are “like me” (from 14 respondents, ranging from a 43-year-old woman to an 84-year-old man). Of those completing follow-up (n = 15), 87% said videos helped them. Conclusion: Our narrative “talk story” intervention showed promise as a culturally relevant method to share patient experiences and reduce health disparities.

BackgroundLittle is known about the burden of heart failure among indigenous populations, including Native Hawaiians (NH). Recent concerns about genetic research in the NH community resonate with similar concerns raised by American Indian, Alaskan Native and Canadian First Nations communities and have raised questions about the best way to proceed with studies involving biological specimens.ObjectiveTo help us plan a study to investigate disparities in heart failure incidence and outcomes in a NH community, we performed a qualitative study to examine the community's expectations for heart failure research that includes the collection of biological specimens.MethodsEighty-five NH with a personal or family history of heart failure, who lived in a geographically isolated community in the state of Hawai‘i participated in 1 of 16 semi-structured interviews. Interviews were conducted in a standard manner, with open-ended questions designed to explore their expectations for a heart failure research study that included the collection of biological specimens. Interviews were analyzed thematically through iterative readings and coding. ResultsFour key themes regarding heart failure research with the use of biological specimens characterized their expectations: (a) Need to foster trust between investigator and community; (b) Establish a partnership with the community to identify needs and goals; (c) Need for mutual benefit to investigator and community; (d) Identification of a key voice to represent the community. Participants expressed strong support for research. However, the strength of that support was directly related to the strength of the relationship between the research team and the community. The collection of biological specimens for genetic analyses was not an explicit concern or barrier per se.ConclusionsIt appears feasible to conduct a heart failure research study that includes the collection of biological samples. However, success will likely require addressing the community's expectations, including the need for a long-term partnership built on trust and mutual benefit, and a key voice to represent the community.

Objectives Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare. Methods Adults hospitalized with a heart disease or diabetes-related PHH in Hawai‘i ( N = 22) were assessed for health literacy and social network membership (“alters”). Results Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters (“isolates”). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend ( p = .055) towards less interest in social network engagement. Discussion In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.