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Published in final edited form as: Public Health Nurs. 2023 Aug 2;40(6):836–843. doi: 10.1111/phn.13234

Utilizing Filipino key informants to guide community outreach for cancer prevention in Hawai’i

Mark L Willingham Jr 1, Angela Sy 2, Munirih Taafaki 2, Reyna Bodnar 1, Tressa P Diaz 3, Lilnabeth P Somera 4, Christina Lucy Porte 5, Clementina D Ceria-Ulep 6, Annilet Pingul 7, Jeny Bissell 8, Kevin D Cassel 1
PMCID: PMC11115969  NIHMSID: NIHMS1990056  PMID: 37530122

Abstract

Objective/design:

The University of Hawai’i Cancer Center works with academic and community partners to examine health disparities and inequities that persist among Pacific Island Populations through the Pacific Island Partnership for Cancer Health Equity (PIPCHE). The Partnership’s Community Outreach Core (COC) assists and promotes cancer research and helps to ensure the integration of historically excluded community perspectives by utilizing community-engaged and culturally-grounded approaches to reduce cancer burdens. However, cancer health disparities among Filipinos demonstrate a need for cancer-control initiatives within this community.

Sample/measurements:

COC staff conducted five semi-structured key informant interviews with Filipino nurse and healthcare leaders in Hawai’i to establishpartnerships with the community, as well as provide community-driven guidance for future cancer prevention and control efforts.

Results:

The informants provided recommendations for COC community engagement, relationship building, and future areas of directed cancer focus. The interviews also initiated relationship-building and community collaborations for directed cancer education and resources within Filipino communities.

Conclusion:

The themes uncovered from the interviews provided guidance on how to begin addressing cancer concerns, and led to the informants’ subsequent membership in our Outreach Advisory Council to engage in future collaboration with the Filipino community and a framework for future community-engaged cancer prevention efforts.

Keywords: cancer, cancer prevention, CBPR, Filipino, key informants

1. INTRODUCTION

Since 2003, the University of Hawai’i Cancer Center and the University of Guam have worked in partnership to explore cancer disparities and inequalities among Pacific Island Populations, as cancer remains the second leading cause of death in the U.S. (Center, 2021). Investigators have explored cancer and health behaviors, health disparities, and health inequities among the peoples of Hawai’i, Guam, and the neighboring U.S. Associated Pacific Islands (USAPI) through the Pacific Island Partnership for Cancer Health Equity (PIPCHE) (Center, 2021; Leon Guerrero et al., 2020). PIPCHE, referred throughout this work as The Partnership, is one of 16 national Partnerships to Advance Cancer Health Equity, a National Institutes of Health, National Cancer Institute (NCI) program. These initiatives provide funding and institutional support to develop partnerships between institutions serving underserved and historically excluded populations, and NCI-designated Cancer Centers to conduct cancer disparities research and advancements to underserved communities (NCI, 2015).

The overarching goal of The Partnership is to promote cancer health equity and alleviate the impact of cancer by increasing cancer research, knowledge, and capacity in Hawai’i, Guam, and the U.S. Associated Pacific Islands because of the elevated adverse health outcomes in these communities (Guam, 2021). Hawai’i consists of a population of around 1.4 million, mainly residing on seven inhabited islands. Hawai’i’s population is ethnically diverse with many Asian and Pacific Islander cultures and languages (Cassel et al., 2020b; Hernandez et al., 2017).

Hawai’i’s ethnically diverse populations experience varying health outcomes grounded in social, biological, and environmental determinants of health and health inequalities/disparities driving poor health outcomes. Disaggregated data among Asian and Pacific Islander ethnic groups in Hawai’i indicate that Pacific Islanders and Filipinos experiences unique health disparities (Aflague et al., 2023; Cruz et al., 2021). In Hawai’i, Filipinos have the highest overall incidence of cancers among Asian ethnicities (HI Tumor Registry, 2022), thus indicating a need for the prioritization of the community’s cancer burden to aid in achieving parity in cancer control by The Partnership.

1.1. The partnership’s community outreach core

The Partnership’s Community Outreach Cores’ (COC) objectives include assisting and promoting The Partnership’s research, ensuring the integration of Pacific Islander community perspectives, building healthcare providers’ competencies, and helping to train new cohorts of Pacific Islander cancer researchers and health care providers. The COC aims to address the disproportionately high rates of cancer incidence and mortality found amongst native community members in Hawai’i and Guam (Palafox et al., 2018; PIPCHE, 2021). The COC strives to achieve these aims by utilizing community-engaged and culturally-grounded approaches to reduce cancer burdens (Cassel et al., 2020a, 2020b; Lee et al., 2019). Members of the COC implement evidence-based cancer prevention outreach efforts. However, the COC’s work has not included a focus on Filipino communities. Health outcomes and priority areas for the Filipino community are often masked due to the lack of disaggregation of this group from the overall Asian and Pacific Islander ethnicity data on health, cancer prevention, and control outcomes (Raquinio et al., 2021; Yu et al., 2004). Recent health indicators demonstrate a need for cancer prevention within this population as true disparities are often not highlighted as health indicators are blended in with overall Asian and Pacific Islander categories (Cruz et al., 2021). This work reflects Hawai’i-based COC efforts to begin addressing the health and cancer concerns of the Filipino community.

1.2. Filipino health in Hawai’i

Filipinos in the U.S. experience cancer risks as a result of health-related racial/ethnic disparities and socioeconomic inequalities. Filipinos were amongst the earliest U.S. immigrants with multiple waves of migration, and Filipinos remain a fast growing segment of the U.S. population. U.S-based foreign occupation and influences from American and Spanish subcultures have led to a myriad of customs and religious identities for Filipinos guiding experiences and behaviors of the community, furthered by generational effects (Maxwell et al., 2003; Sanchez & Gaw, 2007). Filipino Americans experience emotional, behavioral, and social challenges impacted by biculturalism as their historical life experiences, ethnic cultural values, and traditions all influence their mental and health well-being (David, 2010; Gong & Tacata, 2003; Sanchez & Gaw, 2007). Health-related disparities and the limited engagement with healthcare within the Filipino community may be tied to historical, cultural, and socioeconomic influences and experiences (Maxwell et al., 2003; Sanchez & Gaw, 2007; Sentell et al., 2013).

According to the American Community Survey, 37.6% of Hawai’i residents identify as Filipino or part Filipino. Since 2010, Filipinos have been the largest Asian ancestry group in Hawai’i according to the 2010 U.S. Census; 56% of this group are first-generation immigrants (Cruz et al, 2021). As such, communication and language challenges, including health literacy, persist as barriers to health-seeking behaviors and preventive care (Cruz et al, 2021; Sentell et al., 2013). Despite an often lower body mass index than other racial groups, Filipinos are at higher risk of developing type 2 diabetes, as well as a higher prevalence of risk factors for chronic diseases including obesity, smoking, binge drinking, and cancer incidence and mortality (Raquinio et al., 2021; Torre et al., 2016; US DHHS, 2021). In Hawai’i, Filipinos experience higher cancer burdens when compared to other racial and ethnic groups, including other Asian groups (Jin et al., 2016; Lee et al., 2021).

When disaggregated data among Asian ethnic groups are available, cancer related disparities among Filipinos are uncovered. Using the Hawai’i Behavioral Risk Factor Surveillance System (BRFSS) data, Domingo et al. (2018) found that Filipinos were 44% less likely to be colorectal cancer screening compliant than Whites. The 2014–2018 Hawai’i Tumor Registry: Cancer at a Glance (2022) indicated Filipinos had the highest proportions of advanced stage prostate cancer, and incidence and mortality of cancers varied across Hawai’i’s five major ethnic groups (Native Hawaiians, Filipinos, Chinese, Japanese, and Whites). The same report indicated that Filipinos had high incidence and mortality rates of lung and bronchus cancer, and thyroid cancer was highest among Filipino women (Hawai’i Tumor Registry, 2022). Breast cancer age-adjusted mortality per 100,000 for Filipino Women between 2014 and 2018 was 13.2, compared to 7.5 for Chinese women (Hawai’i Tumor Registry, 2022). Prostate cancer age-adjusted rate per 100,000 mortality for Filipinos was 16.4, compared to 5.5 for Chinese and 8.7 for Japanese individuals within the same timeframe (Hawai’i Tumor Registry, 2022). These findings further demonstrate differences within Asian ethnic subgroups in cancer risks, disparities exist in access to cancer prevention efforts, and there remains a need for culturally-grounded approaches to achieve cancer control and health equity (Jin et al., 2016).

Community-based participatory research (CBPR) is a research approach that fosters equitable relationships between academic and community as research partners, and ensures mutual benefit and long-term commitment to the communities and the organizations that serve them (Wallerstein & Duran, 2006). Community engagement is essential to determine the most acceptable approaches to working with historically marginalized communities where health disparities persist (Javier et al., 2010, 2014; Wallerstein & Duran, 2006), such as Filipinos in Hawai’i. As a result of the disaggregated data revealing ethnic disparities for Filipinos, Community Outreach Core efforts expanded to include a focus on Filipino communities. To initiate community-relevant cancer prevention strategies and to determine where and how to begin these efforts to serve the community, the Community Outreach Core worked to understand the unique environmental, cultural, and social determinants that drive cancer disparities within Filipino communities in Hawai’i. Language congruent services for management of chronic diseases was found in a qualitative study examining implications for health promotion among Filipino migrants in Australia and chronic disease experiences; furthermore, these findings concerning language access are also relevant in North America with large diaspora of Filipinos (Maneze et al., 2018; Yu et al., 2004).

The purpose of our research is to describe our community engagement activities, guidance and recommendations provided by members of the Filipino community. Semi-structured key informant interviews (KII) with Filipino leaders provided recommendations for the COC community engagement, relationship building, and directed future areas of cancer prevention focus. These also served to initiate relationship-building and recruit representation to the COC’s Outreach Advisory Council to help guide future efforts within the Filipino community.

2. METHODS

2.1. Recruitment and KI interviewees

One Co-Principal Investigator with personal and professional relationships with the Filipino community in Hawai’i provided our COC team with contacts from Oahu and Maui islands who are involved in Filipino-based organizations serving this population and were approached for involvement with KII via their preferred contact methods. These individuals provided years of experience working with and serving in some health capacity through Filipino-focused organizations and charity work thus providing designation as key informants. Criteria for inclusion were potential interviewees self-identifying as a Filipino, over age 18, living in Hawai’i, and working broadly within the healthcare field. These contacts ranged in terms of education and years of work experience within the health field; however, all were born outside of the U.S., migrated to the U.S., and worked with the Filipino community through various health initiatives targeting all ranges of socioeconomic statuses. Therefore, all had considerable experience working with and providing care for Filipino populations and have lived experiences with cultural and social determinates of health affecting the community. Participants were informed that the interview would be held virtually to ensure COVID-related safety, recorded and later transcribed, and that any identifying records would be destroyed to ensure participants’ confidentiality. COC staff maintained ongoing communication with these potential participants until an agreed-upon date and time for virtual interviews could be set.

2.2. KII questions and interview format

COC staff utilized a shared decision-making and editing approach to create the KII questions. Members of the COC created the interview instrument, guide, and interview script.

COC staff agreed to a final list of 12 interview questions allowing interviewees adequate opportunities to provide their input through a semi-structured interview format. Questions consisted of participants’ background, their interpretations of the overall Filipino community health, future cancer areas of focus, and prevention measures regarding cancer in the Filipino community. Open-ended questions included “Please describe some of the observations or views you have regarding the health of the Filipino community?,” and “How might the UHCC help improve these cancers or cancer topics, or ways to assist with improving the health conditions for the Filipino community?.”

The COC utilized semi-structured interviews to allow for informal conversations to foster themes to emerge more naturally to illuminate health and cancer concerns of importance to interviewees. Most questions were scripted and listed within the interview guide; however, the interviewer encouraged the informant to lead the conversation and added a looser set of questions as part of the interview schedule (Berg & Lune, 2012). Semi-structured interviews allowed us to develop, adapt, and generate questions and follow-up probes appropriate and specific to the objective of the interviews (Berg & Lune, 2012).

In March 2021, five KI interviews were conducted virtually. The interviews ranged from 45 min to 1 hour in length. At least two COC staff were present during all interviews. One staff member conducted the interview while the other took detailed notes. Interviews were recorded over Zoom video platform for later transcription. Additionally, the COC staff created pseudonyms for each interviewee (R1-R5) and destroyed the recordings after transcription to protect interviewee confidentiality. Data was stored on a secure system at the UHCC and within the UHCC’s internal secured network and only accessible by COC staff while at the UHCC.

2.3. Qualitative analysis

COC staff transcribed the audio recorded interviews verbatim. Audio recordings were deleted after transcription to protect participants’ identities. Grounded Theory guided the thematic analysis to generate theory and advance the theoretical understanding of health behaviors within this population (Chun Tie et al., 2019; Glaser & Strauss, 1967; Glaser & Strauss, 2017). This thematic analysis allows for identifying patterns and meanings found within the data. The written transcripts were coded for themes and sorted into coded classifications based on similarities, dissimilarities, and patterns within the interview data (Berg & Lune, 2012). This flexible approach to analysis allowed the COC staff to interpret common trends and insights shared by the interviewees. Procedures to improve the quality of the thematic analysis process involved co-coding and identifying the reliability of coded themes by creating individual coding charts and cross-checking themes uncovered within group analysis meetings (Busetto et al., 2020). The COC confirmed themes uncovered from the interviews by cross-checking codes to arrive at a consensus on the saturation of data and agreement on the themes found.

3. RESULTS

The five participants all identified as female, were born in various parts of the Philippines, all migrated to Hawaiʻi at various ages, and lived on either Oahu or Maui. Interviewees provided current and previous occupations (with multiple interviewees holding more than one occupation) ranging in healthcare from practicing nurses, retired nurses, nursing educators, faculty within a major university, health program administrators, and non-profit COVID-19 related work. All were involved in the community through their vocations and served or volunteered within Filipino communities. Informants identified a range of health and cancer-related topics, options for future interventions, as well as barriers to care uncovered from their lived experiences as part of the Filipino community. Utilizing Grounded Theory as a guide, the themes agreed-upon and uncovered from the interviews included health concerns, areas of the community promoting or hindering cancer care and prevention, types of cancer affecting the Filipino community, Filipino culture/behaviors, and resources needed to address cancer concerns. These main social processes were systematically discovered through coding and analysis of the interviews, and provided the theoretical framework and categorization for these results relating to cancer and health within the Filipino community in Hawai’i (Glaser & Strauss, 1967).

3.1. Health concerns of the community

Key informants described risk behaviors and lifestyle characteristics affecting the health of the Filipino community including being overweight and obese, physical inactivity, and a cultural departure from eating healthy foods. All of the discussed risk behaviors and lifestyle characteristics directly support increases in hypertension, high blood pressure, and diabetes. All of the key informants discussed how traditional healthy foods have been substituted with prepared food high in saturated fats, salt, and sugars. R3 described the role of food as affecting health, “It’s hard to get them (Filipinos) to eat fresh greens” and “They have all of these various servings, you know, and so much processed food.” Informants also described Filipinos as engaging in events and important cultural gatherings in which balanced diets are not the norm, and individuals have too many servings of unhealthy food, including fried foods. Interviewees all described a need for better understanding of food in relation to health and how to approach healthier eating when celebrating with friends and family.

R4 described the role of obesity within the Filipino community. R4 stated, “...obesity is tied to so many diseases and non-communicable diseases that people don’t realize that it’s a huge problem.” She also indicated that many people from the community do not realize how linked food and obesity are to health disparities and cancer risk behaviors. Other informants also described the onset of obesity and non-communicable diseases (NCDs) within the community as a new and emerging trend leading to increased incidence and mortality relating to diseases needing culturally grounded and translated educational resources.

3.2. Types of cancer affecting the Filipino community

Informants described the types of cancer affecting the Filipino community or cancers that the informants have experienced within their own lives or the lives of their family or friends. The three most common cancers discussed within the interviews were colon, breast, and lung cancers as problems affecting the community. When describing the types of cancers facing the Filipino community, R3 provided their thoughts on the most common types of cancers, “I think that the breast cancer and the colon cancer are the top two in terms of cancer.” R5 discussed breast cancer as a common cancer she is aware of and described why this cancer is common, “Cancer of the breasts, they don’t go screen for the mammogram, ...they don’t like to go and educate themselves.” In providing recommendations, all key informants indicated cancer as a major concern for Filipino communities, lack of preventive care, and the importance of faith-based institutions as a vital partnership to address the health disparities related to cancer incidence and mortality.

3.3. Cultural facilitators and barriers to cancer prevention

Interviewees characterized Filipino cultural characteristics and behaviors as both promoting and hindering healthy behaviors and cancer screenings. One common factor that came up throughout all interviews was the role of language. Key informants described the need to seek primary care physicians for cancer screenings and continued care. However, a lack of Filipino primary health professionals were hindrances to health service utilization as Filipinos may not feel comfortable describing health concerns or face problems meeting an understanding because of language barriers to be able to communicate. R1 described problems seeking healthcare due to language barriers, “they’re not fully able to communicate how they feel if they’re being interviewed in English or, you know, they’re not able to express all those health concerns that they’re experiencing.”

The key informants indicated that members of the Filipino community do not feel comfortable seeking healthcare or receiving medical advice for cancer screenings if they are unable to comprehend the words and overall message due to language barriers. R2 further expressed the role of language and the importance of having Filipino healthcare professionals, especially for some older Filipinos, “They’d rather stay with so-and-so because he’s been their doctor so many years and they like him and he speaks my own dialect.” Physicians and healthcare providers who are part of the Filipino community or speak their languages may encourage many to seek healthcare and engage in preventive cancer practices, as well as having available translators or interpreter resources are crucial within healthcare interactions or cancer-based education. R5 indicated a lack of trust and a sense of uneasiness in utilizing healthcare services, thus causing individuals to seek care retroactively versus proactively with cancer screenings. “They don’t like to go to the doctor. Even if they feel anything they don’t like to go to the doctors. I know they don’t want to hear big news and they only call when it’s too late...they don’t want to do the prevention first.”

Other barriers to health-seeking cancer behaviors and use of services concerned resources. R4 recounted difficulty navigating the internet to find health information and cancer advice and relying on family members to assist in finding this vital information. This was brought up in other interviews as potential hindrances to accessing cancer health information because many elderly Filipinos do not have the capability and technological acumen to seek out this information for preventive cancer practices.

According to interviewees, faith and religion remain a common priority among Filipino community members, and religious beliefs guide behaviors and health-seeking practices involving cancer screenings. R3 described religion as a vital institution and staple of Filipino behaviors, “Filipinos are very, involved in their faith, you know, based communities...their faith is very strong, you know, and that is, that’s second to family.” Interviewees all indicated faith-based communities as a partnership needed to improve health conditions for Filipino communities and provide accurate cancer information to achieve better health outcomes.

3.4. Resources to consider for cancer prevention

Cancer remains a major concern, and resources to reduce cancer prevalence are not reaching the Filipino community according to all informants. All interviewees described working multiple jobs because of their dedication to working hard, which hinders opportunities for self-care, including preventive cancer screenings and health check-ups. R5 indicated, “They (Filipinos) busy working that’s why. Even if they feel something, they scared, they still go to work.” The need for more education around the importance of self-care relating to cancer screenings and when to engage in screenings was identified.

R2 also explained that many Filipinos hold numerous jobs and place their need for work above their own health because Filipinos have to work several jobs to afford life in Hawai’i and to send money back home to family. Therefore, cancer education and programs have to fit within their lives and what they value, as well as be culturally relevant. R2 recommended that the message needs to stand out given daily obligations, “(Cancer messaging) has to come from trusted individuals that will motivate, propel them to see—or to access the information and to seek screening services or care before it’s too late.” R3 further explained the need to “Integrate health education and health promotion...we find a way to make it relevant and we try to connect” in regards to improving cancer screenings and health conditions for Filipino community members.

Church organizations and radio advertisements were noted as the most effective setting to prioritize providing education and resource sharing. R2 stated, “working through churches is good. Another source would be to make announcements in radio stations.” R4 also expressed the potential use of radio to reach Filipinos, “Filipinos do listen to the radio, Filipino radio. That would be a good way of getting to the Filipino community.” Some indicated the use of brochures and pamphlets as a way of providing resources about cancer screening behaviors and facts; however, a few interviewees expressed hesitation that Filipino community members would read these materials even if translated into the Filipino languages.

4. DISCUSSION

The community key informant experts provided a wealth of information and insight into better understanding the Filipino community’s cancer prevention, health education, and cancer promotion needs in Hawai’i. The themes uncovered from the interviews included the major health concerns of the community, as well as societal facilitators promoting, and barriers hindering cancer care and obtaining screenings, as suggested by recent findings (Aflague et al., 2023). Grounded Theory served to advance the theoretical understanding of health behaviors and areas of cancer concern within this population and guided our qualitative analysis (Chun Tie et al., 2019; Glaser & Strauss, 1967; Glaser & Strauss, 2017). The interviewees also uncovered the types of cancer affecting the Filipino community and Filipino cultural values affecting cancer care and obtaining cancer screenings. The three most common cancers discussed were colon, breast, and lung cancers, all of which remain among the top cancer incidence in Hawai’i for Filipinos (Hawai’i Tumor Registry, 2022), and serve as areas to focus efforts for future cancer prevention and control efforts.

Interviewees expressed concern over increased NCDs and overweight trends within the Filipino community as a result of unhealthy lifestyles, which is further exacerbated by a complex intermix of biological, environmental, and social determinants driving poor health outcomes (Maxwell et al., 2003; Sanchez & Gaw, 2007; Sentell et al., 2013). Interviewees highlighted how Filipinos do not link the role of behaviors and lifestyles in relation to increased cancer prevalence and incidence. Discussions around NCDs and the lack of tailored health and cancer resources may explain the persistently high NCD prevalence among Filipinos. Tailored health resources would better address the contributing factors such as emotional, behavioral, and social challenges impacted by biculturalism with Western and ethnic cultures as their ethnic cultural values and traditions influence overall well-being (Raquinio et al., 2021; Sanchez & Gaw, 2007; Torre et al., 2016). The COC has joined and partnered with Filipino community organizations at different health fairs and events to promote cancer education and provide resources explaining the types of cancer affecting the community, when to get screened and who should get screened, as well as cancer-based education to address misunderstandings around health and cancer.

Informants identified many healthy aspects of the Filipino community, such as hard work, prioritizing family, and the role of faith and religion guiding positive life outcomes. Faith-based organizations would be important partners and settings to deliver cancer and other health promotion programs for the UHCC and other Filipino-serving organizations. The COC reached out to local Filipino churches and faith-based institutions to provide education, and successfully provided colorectal cancer education at one church thus far.

Health literacy remains a major barrier to accessing health services for Filipinos in Hawai’i, as indicated by previous literature (Cruz et al., 2021; Sanchez & Gaw, 2007; Sentell et al., 2013). Services offered in Filipino languages needs to be expanded, and the community needs access to translated health promotion materials and prevention guidance such as cancer screening guidelines consistent with previous findings (Maneze et al., 2018; Yu et al., 2004). Furthermore, where to focus language interpretation and translation and educational efforts requires further exploration, as some key informants thought pamphlets/brochures in Filipino languages may be the best resource. Others felt that those materials may not be read even if translated. Utilizing existing channels of communication for Filipinos such as local radio broadcasting or television shows dedicated to Filipinos in their languages, or even bus advertisements, may better reach them in providing education on interventions regarding cancer care. In response, we are translating a nationally-utilized and evidence-based colorectal cancer screening education and knowledge toolkit to Ilocano to provide as resources to the community and Filipino-community partners.

The KIIs initiated and catalyzed a partnership between the UHCC and community members to advise on cancer concerns of the Filipino community in Hawai’i. This collaboration supports the direction of The Partnership based on CBPR approaches and principles (Javier et al., 2010, 2014; Wallerstein & Duran, 2006). The inclusion of community key informants to advise on our directions will help to continue to foster CBPR and that community and culturally tailored approaches remain a priority for project objectives and aims. UHCC COC staff strives to continue seeking informants’ expert guidance through the inclusion into our Outreach Advisory Council. Therefore, we invited these key informants to serve on The Partnerships’ Outreach Advisory Council to provide guidance for current and future cancer prevention initiatives and areas of focus with Filipinos and other underserved communities in Hawai’i. Four out of five of the key informants now serve on the project’s Outreach Advisory Council, a direct result of the KII and the relationships built from these interviews. The COC meets with the Outreach Advisory Council regularly to discuss future Partnership projects in Hawai’i and their communities’ cancer needs. Our collaboration efforts have led to our expanded partnerships to the island of Maui, where we provided in-person resources to the community.

To our knowledge, there are few, if any published qualitative studies of risk and protective factors for cancer prevention and the provision of specific recommendations specifically by and for Filipino Americans. The new Outreach Advisory Council members explained and contextualized Filipinos’ health perceptions and behaviors in Hawai’i. The members recommended areas for future interventions and community education, identified the cancers affecting their communities and resources needed for health promotion including cancer prevention. This assessment provided rich descriptions regarding cancer prevention priorities, facilitators and barriers to screening, and recommendations for future health promotion for Filipinos in Hawai’i.

4.1. Limitations

This study is limited by the low sample size, lack of male Filipino insight, and the higher education of the participants; however, all interviewees have lived experiences and worked with members of the Filipino community within Hawai’i. Our goal was to have a better understanding of the health concerns and barriers or supports to cancer care/screenings within the Filipino community and we used our teams’ social networks to recruit the five individuals because of their connection to the community and work within the health field. Further snowball sampling would have provided a larger sample and a better representation of the community and generalizable findings, and should be considered for future studies and exploratory analysis. However, time and resource constraints did not allow this, yet this recruitment did provide us four members to serve on our Outreach Advisory Council. This allows for these continued conversations, connections to Filipino community organizations and events for future efforts/resource sharing, and opportunities to provide cancer education and resources to the community.

5. CONCLUSION

Community guidance to inform areas of focus of The Partnerships’ research is fundamental for the COC. The Partnership requires expertise from the communities it serves to help guide relevant and respectful approaches to resolve cancer disparities. The Hawai’i COC engaged with key informant representatives to advise on cancer control priorities for the Filipino community. These KII identified cancers to prioritize, while providing continued collaboration with community members to guide research efforts for the duration of this Partnership. The KII discussions led to the representatives’ subsequent membership in our Outreach Advisory Council to ensure future collaboration with the Filipino community, demonstrating a way of engaging community members and building relationships within research. The processes of engagement described in this article will continue to provide for community-engagement to guide future research efforts that aim to improve health equity with preventive interventions that are community partnered and led.

ACKNOWLEDGMENTS

The COC staff would like to thank the key informant leaders for their expert guidance on cancer and health-related topics for the Filipino community, as well as the staff, students, and personnel who contributed to this work and COC efforts. Content reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U54CA143727 and U54CA143728. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report there are no competing interests to declare.

Footnotes

DECLARATIONS, AND ETHICS AND CONSENT STATEMENTS

Our study did not require ethical board approval because we determined this project did not meet human subjects research, as such, did not require review and approval by the Human Studies Program or a UH Institutional Review Board (IRB). To qualify as human subjects research, as defined by federal regulation, a project must qualify as a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge. Our work was not used to answer a hypothesis but rather inform relationship building and later efforts. Also, this project did not involve obtaining information about living individuals through any private information from which individuals can be identified directly or indirectly through a link or code. We gained verbal consent to take part in the interviews and record the audio recording for transcription; however, the recording was deleted after transcription and we removed any identifiable information. We also gained consent for the manuscript creation and final comments from interviewees before submission.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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