Native Hawaiians; cancer; clinical trials; gender norms; disparities; distrust


Community Health and Preventive Medicine | Medicine and Health Sciences


Understanding low rates of participation by minority populations in clinical trials is critical for reducing and eliminating disparities. We examined beliefs and attitudes of Native Hawaiian men related to illness and cancer to better understand their rates of participation in clinical trials. We conducted face-to-face interviews with Native Hawaiian key informants throughout the State of Hawai‘i using quota sampling methods to obtain a range of perspectives about attitudes towards health care seeking to provide insight into low clinical trials participation. Interviews were audio-taped, transcribed, and independently coded by researchers. Thematic analysis guided the extraction of relevant data from the discussions. Key informants (N=16) suggested the following beliefs and attitudes regarding clinical trials participation: 1) mistrust in the healthcare system, 2) external locus of control, 3) gender norms, and 4) the customary pono (righteousness, to make right) practice towards family/community to model and maintain good health, including participation in cancer clinical trials. Native Hawaiian men in this study expressed hesitation in the benefits of formalized health care. Many men described experiences of racism, inequity, and injustice associated their interactions with health care providers. These encounters were factors that influenced their healthcare practices and beliefs towards maintaining health and longevity.