wahiawa center for community health final report - wahiawā, waialua, mililani… · 2018-01-25 ·...

Wahiawa Center for Community Health 1

Running HEAD: WAHIAWA CENTER FOR COMMUNITY HEALTH

Wahiawa Center for Community Health

Community Health Assessment

Cortney Midla

University of Hawaii

Summer 2012


Introduction

Wahiawa is a small, rural community in central Oahu with a rich history. Kukaniloko,

located right outside of Wahiawa and cared for by the Hawaiian Civic Club of Wahiawa, is

known as the piko (navel) of the island of Oahu, as it is at the center of the island and has an

important history related to birth (Hawaii State Department of Land and Natural Resources,

n.d.). This sacred, ancient Native Hawaiian site was constructed in the 11th century A.D. as a

place for the birth of ali’i (Native Hawaiian royalty), astronomical observation, and navigation

education (Barron, 2011). The importance of fertility to the area extended from the people to the

land, and in the 1800s, King Kamehameha I, the king who united the islands of Hawaii, decided

to develop Wahiawa as an agricultural area, particularly for the production of pineapple (Hawaii

State Info, 2006). The production of pineapple continues today on a smaller scale through the

Dole Plantation (Hawaii State Info, 2006).

Map data 2012 Google

Wahiawa


In 2011, Faith Action for Community Equity (FACE) was approached by Senator Daniel

Inouye’s office to apply for a Health Resources and Services Administration (HRSA) planning

grant. The purpose of the planning grant, awarded in September 2011, was to gather information

to submit a proposal for funding a new community health center in Wahiawa, the last area in the

state with a sizable population without its own community health center. In order to understand

the health disparities experienced by members of the Wahiawa community and to determine the

need for a community health center, a quantitative and qualitative community health assessment

was performed in conjunction with the University of Hawaii School of Nursing and Dental

Hygiene.

According to the 2010 U.S Census, the population of Wahiawa was 17,821. The

demographics of Wahiawa were quite different from the state of Hawaii in general. In Wahiawa,

17.1% of the population reported being over the age of 65 compared to 14.3% for the state (U.S.

Census Bureau, 2012). Only 9.7% of people in Wahiawa reported being “White, not Hispanic”

compared to 22.7% for the state of Hawaii, and 13% reported being Hispanic/Latino compared to

8.9% for the state of Hawaii (U.S. Census Bureau, 2012). The median household income in

Proposed site for Wahiawa Center for Community Health (rented office in Wahiawa Medical Arts Building)


Wahiawa from 2006 to 2010 was $51,667 compared to $66,420 for the State of Hawaii (U.S.

Census Bureau, 2012). The percentage of people reporting living below the poverty level was

12.6% from 2006 to 2010 compared to 9.6% for the state of Hawaii (U.S. Census Bureau, 2012).

Because of the high cost of living in the area, it is important to consider that 32% of households

in the community lived below 200% of poverty level (Hawaii State Department of Health, 2012).

Only 18.2% of adults over the age of 24 from 2006 to 2010 reported having at least a Bachelor’s

degree compared to 29.4% for the state of Hawaii, and 83.4% of adults over the age of 24 from

2006 to 2010 reported graduating from high school compared to 89.8% for the state of Hawaii

(U.S. Census Bureau, 2012).

The economic situation of the area appears even more bleak when information from

nearby Schofield Barracks, a military base with a population of 16,370 (U.S. Census Bureau,

2012), is included. The median household income of Schofield Barracks from 2006 to 2010 was

$41,602, much lower than the state average of $66,420, and an alarming 18.2% of the population

reported living below the poverty level (U.S. Census Bureau, 2012).

Evidence of socioeconomic disparities were also found when examining school data

within the Leilehua complex. For example, during the 2010-2011 academic year, 82.2% of

Ka’ala Elementary students received free or reduced price lunch, and only 26% of kindergartners

had attended pre-school (Kaala Elementary, 2011). Wahiawa Elementary was somewhat better

with 65.3% of students receiving free or reduced price lunch and 42% of kindergartners

attending pre-school during the 2010-2011 academic year (Wahiawa Elementary, 2011).


Methods

The community health assessment was conducted through surveys, focus groups, and

personal interviews. The initial version of the survey had open-ended questions to assess the top

five health/social problems/needs in the community and the top five services desired.

Community members indicated that it was cumbersome to complete the open-ended questions,

so a second survey was developed by examining the answers from the first survey to offer

checkbox choices for the top five health/social problems in the community and the top five

services desired. It was also decided to replace the choice for government affiliation with a

choice for union affiliation. A third version of the survey requested information about health

care access, in addition to health/social problems and desired services. This was an anonymous

survey, reviewed and approved by the Hawaii State Department of Health Institutional Review

Board and the Hawaii State Department of Education to distribute to parents of schools in the

Leilehua Complex.

Surveys were distributed at churches, public meetings, such as neighborhood board

meetings, community organization meetings, such as Lion’s Club meetings, public outreach

events, such as the wellness expo sponsored by the project, and schools, through inclusion in

newsletters to parents. A total of 908 surveys were returned: 203 of the first version, 611 of the

second version, and 94 of the final version. Descriptive statistics were generated using Microsoft

Excel.

Focus groups were conducted for vulnerable populations for which surveys were not

appropriate, such as those with language, literacy, and income barriers. These included the

Chuukese community, public housing community, and senior housing community. To reach

members of the Chuukese community, invitation was by word of mouth, as culturally


appropriate. Interpreters assisted with focus groups to improve communication between the

facilitators and participants. For public housing and senior housing focus groups, flyers were

posted to advertise the gatherings. At the end of all focus group meetings, summaries were

shared to ensure that important issues were identified correctly.

Personal interviews were conducted with physicians and their staff, senior staff at

Wahiawa General Hospital, and community leaders, including elected officials.

Results & Discussion

Demographics

The majority of the survey respondents identified themselves as residents of Wahiawa.

The second largest group identified themselves as residents of Mililani, which is outside the

catchment area to be considered for the community health center application.

Table 1: Top Five Residency Locations of "Other"

Location n %

Mililani 65 38%

Schofield Barracks 22 13%

N/A 14 8%

Honolulu 13 8%

Waipahu 11 6%


Interestingly, only 41% of survey respondents identified themselves as community

members (Table 2), while 72% reported being Wahiawa residents. It is unknown if they did not

identify themselves as community members because they may not view themselves as “active,

involved” members of the community or they did not understand the question. While Wahiawa

is known as having a large retiree population, 23% of respondents identified themselves as being

a young family (Table 2).

Table 2: Affiliations

Affiliation n %

Community Member 374 41%

Young Family 211 23%

Senior 173 19%

Other 142 16%

Other Healthcare Provider 60 7%

Disabled 57 6%

Potential Health Center Patient 55 6%

Social Service/Non-Profit Sector 50 6%

Union Employee* 42 5%

Business Sector 27 3%

Physician 18 2%

Government Employee** 14 2%

*Only 705 of the 908 surveys included this question. The adjusted percentage is 6%. **Only 203 of the 908 surveys included this question. The adjusted percentage is 7%.

Health & Social Problems

The top five problems identified by respondents of the survey are all social determinants

of health: drug use, jobs, housing, affordable child care, and education. Health problems

identified as being important, such as obesity, diabetes, and mental health, were not ranked as

highly as social problems. Some groups, such as seniors, the disabled, and health care providers,

were more likely to identify health problems, such as diabetes, in the top five.


Although mental health and lack of recreation sites did not top the list of problems

identified by the survey respondents, these were common themes among the focus group

participants. Focus group participants spoke at length about the dearth of positive recreational

and community building activities, particularly for youth, and how this leads to drug use and

criminal activities.

It is surprising that cultural and translation services were at the bottom of the list, as

26.5% of Wahiawa residents speak a language other than English at home (U.S. Census Bureau,

2012). It is possible that the survey respondents were self-selected based on ability to read and

write English, so these issues were not identified through the survey. These issues were

identified as being important to the participants of the Chuukese focus group.

Table 3: Health and Social Service Problems

Problem n %

Drug use 514 57%

Jobs 408 45%

Housing 359 40%

Affordable child care 327 36%

Education 301 33%

Obesity 271 30%

Diabetes 242 27%

Mental Health 178 20%

Other 163 18%

Disease prevention/ health promotion 141 16%

Recreation Sites 135 15%

Heart Disease 107 12%

Asthma 107 12%

Chronic disease management 100 11%

Transportation 99 11%

Doctors do not accept Medicare/ Medicaid 97 11%

Cultural issues 83 9%

Translation Services 26 3%


Top Five Problems Identified by Affiliation

Table 4: Community Member

Problem n %

Drug use 219 59%

Jobs 170 45%

Housing 138 37%


Education 128 34%

Table 5: Young Family

Problem n %

Drug use 124 59%

Jobs 102 48%

Housing 97 46%


Education 87 41%

Table 6: Senior

Problem n %

Drug use 84 49%

Diabetes 49 28%

Jobs 48 28%

Housing 47 27%

Other 46 27%

Table 7: Disabled

Problem n %

Drug use 32 56%

Housing 27 47%

Diabetes 22 39%

Jobs 20 35%


Table 8: Potential Health Center Patient

Problem n %

Drug use 29 53%

Diabetes 20 36%

Other 19 35%

Housing 17 31%

Obesity 14 25%

Table 9: Business Sector

Problem n %

Drug use 16 59%

Jobs 11 41%

Housing 11 41% Disease prevention/ health promotion 11 41%

Obesity 11 41%

Table 10: Union Employee

Problem n %

Drug use 35 83%

Housing 23 55%


Jobs 21 50%


Table 11: Social Service/ Non-Profit Sector

Problem n %

Drug use 29 58%

Housing 24 48%

Diabetes 20 40%

Jobs 20 40%




Table 12: Physician

Problem n %

Drug use 9 50%

Obesity 7 39%

Diabetes 7 39%

Housing 6 33%

Mental Health 6 33%

Other 6 33%

Table 13: Other Healthcare Provider

Problem n %

Drug use 32 53%

Housing 24 40% Disease prevention/ health promotion 20 33%

Jobs 18 30% Chronic disease management 17 28%

Diabetes 17 28%

Table 14: Government Employee

Problem n %

Drug use 11 79%

Other 9 64%

Housing 3 21%

Diabetes 2 14% Doctors do not accept Medicare/ Medicaid 2 14%

Jobs 2 14%

Mental Health 2 14%

Table 15: Other

Problem n %

Jobs 74 52%

Drug use 69 49%


Housing 62 44%

Education 61 43%

Health Services

Congruent with the findings regarding health and social service problems in the

community, the top three health services desired by survey respondents - job training/education,

nutrition, and health education - were not related to illness or medical care. Primary care and

mental health care rounded out the top five desired services. Dental services comprised a very

close number six, with 33% of respondents expressing a desire for dental services. It was not

surprising that job training/education was the most desired service, as the median income in

Wahiawa was much lower than the rest of the state, and the area has been transitioning away

economically from pineapple production with a plantation social structure. It was unexpected for

nutrition to be identified as a more greatly desired service than mental health care, as drug use


topped the list of problems, while obesity was sixth on the list, and other potential nutrition

issues, such as food security, were not identified at all.

Table 16: Desired Health Services

Services n %

Job Training/Education 407 45%

Nutrition 374 41%

Health Education 352 39%

Primary Care 312 34%

Mental Health Care 308 34%

Dental 296 33%

Social Workers 265 29%

Health Support Groups 197 22%

Care coordination services 197 22%

Transportation to health providers 166 18%

Immunizations 165 18%

OB/GYN 156 17%

Other 115 13%

Case Managers 108 12%

Orthopedics 81 9%

Top Five Health Services Desired by Affiliation

Table 17: Community Member

Services n %


Nutrition 156 42%

Primary Care 138 37%



Table 18: Young Family

Services n %


Nutrition 95 45%


Primary Care 79 37%

Dental 70 33%

Table 19: Senior

Services n %

Nutrition 54 31%



Primary Care 48 28% Care coordination services 44 25%


Table 20: Disabled

Services n %


Dental 26 46%

Nutrition 21 37%




Table 21: Potential Health Center Patient

Services n %

Nutrition 21 38%





Primary Care 19 35%

Table 22: Business Sector

Services n %


Primary Care 14 52%



Nutrition 11 41%

Table 23: Union Employee

Services n %



Nutrition 21 50%


Primary Care 15 36%


Table 24: Social Service/ Non-Profit Sector

Services n %



Primary Care 21 42%


Dental 17 34%

Table 25: Physician

Services n %

Primary Care 12 67%



Dental 5 28%

Health Support Groups 5 28%

Nutrition 5 28%


Table 26: Other Healthcare Provider

Services n %



Primary Care 23 38%

Dental 21 35%


Table 27: Government Employee

Services n %

Other 7 50%


Primary Care 4 29%

Nutrition 3 21%

Dental 2 14%

Table 28: Other

Services n %

Nutrition 70 49%



Primary Care 51 36%



Health Care Access

According to a recent Hawaii Physician Workforce Assessment, there is a demand for 24

full-time equivalent (FTE) primary care physicians in the Wahiawa area (Withy, 2012).

Unfortunately, there are only 9.1 FTE primary care providers practicing in the Wahiawa area

(Hawaii State Department of Health, 2012), so the ratio of primary care providers to patients in

the area is 1:1,958. While this does not meet the 1:3,500 ratio requirement to be designated a

Health Professionals Shortage Area (HPSA) (National Association of Community Health

Centers, 2011), it is well above the ratio of 1:1,500 recommended by Ricketts, Goldsmith,

Holmes, Randolph, Lee, Taylor, et al. (2007). Of the providers who identified themselves as

providing primary care services, none were OB/GYN providers, meaning that prenatal care had

to be obtained outside the community for the 1,405 live births reported in the area (Hawaii State

Department of Health, 2012). The survey data collected reflect that only about one third of care

was obtained in Wahiawa (Table 29).

As part of the project, a secret shopper contacted all of the practicing providers and

attempted to schedule new patient appointments. Over a period of several weeks in February

2012, she attempted to schedule appointments as a new Medicaid/Quest patient, as a new

Medicare patient, and, finally, a new private insurance patient. She was unable to find any

primary care providers to accept her as a new patient, even with private insurance (B. Harbin,

personal communication, February 24, 2012). In private interviews with physicians,

approximately half have stated that they plan to retire as soon as a community health center

exists in the area, and they have already contracted with real estate agents to market their offices

(B. Harbin, personal communication, July 19, 2012), confirming that providers are limiting

access to their care.


A common theme in focus groups (Appendices A, B, and C) was lack of access to care

because physicians do not accept Medicaid and Medicare. The Hawaii State Department of

Health (2012) reports that 34% of residents in Wahiawa are covered by Medicaid, government

health insurance for the indigent. This is a very large population that is not being served by

currently available providers.

Approximately half of survey respondents reported that they had a doctor visit or a

dentist visit within the last year; however, the sample size for these questions was small, so the

data may not be reliable (Tables 30 & 31). A common theme in focus groups (Appendices A, B,

and C) was that the only dental care covered by Medicaid was tooth extraction, with no

preventive or restorative services covered, negatively impacting the quality of their lives.

Table 29: Location of Medical Care

Location n %

Wahiawa 30 32%

Honolulu 27 29%

Mililani 12 13%

Other 10 11%

Military Facility 9 10%

CHC - CareVan 1 1%

Table 30: Insurance Coverage

Insurance n %

Other Private 33 35%

Tricare 9 10%

Quest 7 7%

Medicare 4 4%

Kaiser 4 4%

None 3 3%

Medicaid 2 2%


Table 31: Last Doctor Visit

Time n %

Less than 1 year ago 51 54%

1 to 2 years ago 11 12%


More than 5 years ago 1 1%

Do not remember 4 4%

N/A 25 27%

Table 32: Last Dentist Visit

Time n %

Less than 1 year ago 45 48%



More than 5 years ago 4 4%

Never 1 1%

Do not remember 2 2%

N/A 25 27%

Conclusion

As this report has demonstrated, the Wahiawa community faces significant

socioeconomic and medical care access disparities. Members of the community recognize that

the social problems in their community (substance use, employment, housing, access to

affordable child care, and education) are negatively affecting the “health” of their community

and want to see changes. The 1978 Declaration of Alma-Ata states that health is “a state of

complete physical, mental, and social wellbeing, and not merely the absence of disease or

infirmity… and that the attainment of the highest possible level of health is a most important

world-wide social goal whose realization requires the action of many other social and economic

sectors in addition to the health sector” (World Health Organization (WHO)). The Declaration

goes on to say that “people have the right and duty to participate individually and collectively in

the planning and implementation of their health care” (WHO, 1978). Members of the Wahiawa

community have actively participated in focus groups, filled out surveys, and attended public


meetings and wellness events to show their support for a community organization to improve the

“health” of their community. They have expressed that they want to see a transformation in

health and social service delivery by embracing the novel idea of a center for community health,

rather than a common community health center, with an emphasis on promoting health for the

entire community.

Dr. David Derauf, executive director of Kokua Kalihi Valley Comprehensive Valley

Health Services (KKV), said at a health care transformation panel in November 2011 that if he

could start KKV from scratch, he would change the name to reflect that the organization was a

center for community health, recognizing that the “health” of the community determines the

health of the individuals in it. The team for the planning grant then decided to name the

proposed community health center “The Wahiawa Center for Community Health.” A center for

community health in Wahiawa could provide jobs, job training, health education, access to health

care, and hope – hope for a rewarding job close to home, hope to develop healthy lifestyle habits,

hope to resist the lure of drugs for a healthy, vibrant future.


References

Barron, K. (2011). Kukaniloko: A living legend (American Astronomical Society, AAS Meeting

#217, #249.13; Bulletin of the American Astronomical Society, 43). Abstract retrieved

August 10, 2012 from http://adsabs.harvard.edu/abs/2011AAS...21724913B

Hawaii State Department of Health. (2012). Medically Underserved Area/Population

Application.

Hawaii State Department of Land and Natural Resources. (n.d.). Kukaniloko Birthstones State

Historic Site. Retrieved August 10, 2012 from

http://www.hawaiistateparks.org/parks/oahu/kukaniloko.cfm

Hawaii State Info. (2006). Wahiawa, Honolulu County, Hawaii. Retrieved August 10, 2012 from

http://www.hawaiistateinfo.com/wahiawa.php

Kaala Elementary School. (2011). School Status and Improvement Report School Year 2010-

2011. Retrieved July 6, 2012 from http://arch.k12.hi.us/PDFs/ssir/2011/Central/SSIR211-

2.pdf

National Association of Community Health Centers. (2011, July). So you want to start a health

center…? A practical guide for starting a federally qualified health center. Bethesda,

MD.

Ricketts, T.C., Goldsmith, L.J., Holmes, G.M., Randolph, R., Lee, R., Taylor, D.H., et al. (2007).

Designating places & populations as medically underserved: A proposal for a new

approach [Electronic version]. Journal for Health Care for the Poor and Underserved,

18, 567-589.

U.S. Census Bureau. (2012). State & County QuickFacts. Schofield Barracks CDP, Hawaii.

Retrieved July 6, 2012 from http://quickfacts.census.gov/qfd/states/15/1569050.html


U.S. Census Bureau. (2012). State & County QuickFacts. Wahiawa CDP, Hawaii. Retrieved

July 6, 2012 from http://quickfacts.census.gov/qfd/states/15/1572650.html

Wahiawa Elementary School. (2011). School Status and Improvement Report School Year 2010-

2011. Retrieved July 6, 2012 from http://arch.k12.hi.us/PDFs/ssir/2011/Central/SSIR229-

2.pdf

Withy, K. (2012). Hawaii Physician Workforce Assessment.

World Health Organization. (1978, September 6-12). Declaration of Alma-Ata. International

Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 [Electronic

version]. Retrieved January 21, 2010 from

http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf


Appendix A Chuukese Focus Group Meeting

Our Lady of Sorrows Church Wahiawa, Hawaii

March 4, 2012, 6:30 pm Summary:

• 5/6 adults stay in Wahiawa for medical care

• One pediatrician accepts Quest

• 1/6 adults go to Kalihi-Palama because she feels more comfortable there and that the staff are more familiar with Chuukese culture

• Although numbers are not available, participants also seek care:

• Queen Emma Clinic

• Kapiolani

• Waianae Comp

• 0/6 have ever been to a doctor for a check-up

• 0/18 have ever been to the dentist for a check-up and cleaning

• 12/12 came to Hawaii from Chuuk for medical care

• 17/18 have MedQuest insurance

• 1/18 has private HMSA insurance

• Main problems o Asthma o Cultural issues o Immigration issues o Unfamiliar with laws (civil rules vs. family rules) o Diabetes o Doctors do not accept Medicare/Medicaid o Insurance does not cover medications prescribed (not on formulary) o Drug use o Kidney disease o Housing o Jobs o Mental health o Family counseling o Translation services o Transportation o Lack of financial education o Lack of dialysis services

• Main desired services o Financial education o Help w/ insurance o Culture


o Translation o ESL o Social center/community hall o Extracurricular/recreation opportunities o Care coordination services o Case managers o Dental care o Health education o Job training/education o Mental health care o Family counseling o Nutrition education o Primary/preventive care o Social workers o What they offer at Queen’s o Durable medical equipment (e.g., electric wheel chair batteries) o Affordable mortuary

Group 1:

• 5/6 stay in Wahiawa for medical care

• 1/6 go to Kalihi-Palama because she feels more comfortable there and that the staff are more familiar with Chuukese culture




• 1/6 has private HMSA insurance

• Main problems o Asthma o Cultural issues o Diabetes o Doctors do not accept Medicare/Medicaid o Drug use o Kidney disease o Housing o Jobs o Mental health o Translation services o Transportation o Lack of financial education

• Main desired services o Financial education o Help w/ insurance o Culture


o Translation o ESL o Social center/community hall o Extracurricular/recreation opportunities o Care coordination services o Case managers o Dental care o Health education o Job training/education o Mental health care o Nutrition education o Primary/preventive care o Social workers o Affordable mortuary

Group 2: Access Care:

• Queen Emma Clinic

• Kalihi-Palama

• Kapiolani

• Waianae Comp

• Wahiawa – pediatrics; one pediatrician accepts Quest

• Question about preventive medical care not asked

• No preventive dental care accessed

• All came to Hawaii from Chuuk for medical care

• 12: all have Quest

• Main problems o Insurance does not cover medications prescribed (not on formulary) o Transportation o Interpretation o Mental health o Family counseling o Immigration issues o Unfamiliar with laws (civil rules vs. family rules) o Housing o Lack of dialysis services

• Main desired services o Family counseling o What they offer at Queen’s o Durable medical equipment (e.g., electric wheel chair batteries)


Appendix B Public Housing Focus Group Meeting

Wahiawa, Hawaii March 9, 2012, 5:00 pm

• 8 adult participants throughout meeting + 2 adult participants who joined toward the end (last question)

• 1/8 stay in Wahiawa for medical care

• Other places that participants seek care are o Kapolei o Pearl Harbor o Waipio o Waianae o Downtown




• 1/8 has Tricare insurance

• 1/8 has HMSA/Medicare retiree insurance

• Main problems o Lack of recreation opportunities o Lack of parenting support o Lack of respect for environment o Doctors do not accept Medicare/Medicaid o Transportation

• Main desired services o Affordable child care o Hawaiian cultural center o Music lessons/sports recreation center o Social gathering place o Food bank o Discount stores to help dollars go further o One stop shop (like Waipio) o Urgent care (ER takes too long) o Eye doctor o Maternity o Hair cutting o Legal rights o Translation o Care coordination services o Dental care o Health support groups


o Mentoring o Job training/education o Literacy, adult ed o Job referrals o Mental health care o Drug treatment o Social workers o Transportation to health providers


Appendix C Waialua Senior Housing Focus Group Meeting

Waialua, Hawaii April 13, 2012, 6:00 pm

Summary

• 13 adult participants throughout meeting

• 1/13 stay in North Shore for care

• Other places that participants seek care are o Wahiawa o Town (Honolulu) o Moanalua (Kaiser) o Waipio (Kaiser) o Ewa Beach o Waipahu o Tripler o Waikiki CHC o Waianae Comp o Palama Settlement

• One individual has been "doctor shopping" because he feels that the providers he has seen do not care for him as an individual, but just as a statistic. He feels that he is not "understood".

• Three individuals report that they can arrange for transportation for their appointments by calling two days in advance (service provided by Evercare or Wellcare). Others reported taking city transportation (the Bus) to their appointments, or to get the prescription medication refilled. For health issues outside of routine follow-up, the emergency room is utilized, usually via ambulance service.

• Participants requested that satellite clinic be set up, so providers could come once a week or once a month

• 5/13 participants reported that they see their physicians monthly for regular follow-up checks

• All of the participants reported that they only go to the dentist for treatment and that their insurance only covers extraction. One participant reported that she used to go for regular cleanings and check-ups when she worked and insurance covered them.

• 2/13 have HMSA Quest + Medicare

• 2/13 have Quest only

• 4/13 have Quest without specifying if they also have Medicare

• 1/5 has Kaiser

• 2/13 have Tri-Care

• 2 uninsured


o One of these individuals had previously had care through the State Quest program, but failed to respond to a choice of providers as requested, and was dropped from the rolls. He is able to get care (indigent care) through the Veterans Ambulatory Care Clinic until he is able to be reinstated with the state Quest program.

o The second did not explain his circumstances for no health insurance coverage, and

related that he had to seek care at another CHC (Waikiki) and was then referred to the Kahuku Hospital to see a physician.

• Main problems o Lack of educational opportunities o Homelessness o Lack of access to showers and clothes for homeless and poor o Lack of recreational sites o Risk of falls o Transportation - Waialua is far from everything (going to the doctor takes all day) o Lack of homemaking/chore services (many old and disabled cannot care for

themselves) o Lack of nutrition o Psychiatric and mental health issues o Doctors do not accept Medicare/Medicaid o Recovered substance abusers o Heart disease o Hypertension o Hypercholesterolemia o Diabetes o Blindness o Deafness o Obesity

• Main desired services o Dental care o Nutrition o Job training/education o Transportation to health providers o Homemaking/chore services o Urgent care o Wound care o Someone to check on elderly o Gathering place/recreation o Exercise classes o TB clearance o BP checks o Diabetes checks o Chronic disease management o Doctors who accept Medicare/Medicaid


o Homelesse services o Drug abuse treatment o Health education o Immunizations o Mental health care

• Other comments/concerns o When a prescription is written for a 30 day supply, the pharmacy will only fill for

15-17 days, requiring a second trip to the Pharmacy and a second co-pay. o When a healthy diet is prescribed, the little money that is left for food is

inadequate to buy the fresh vegetables/fruits recommended for diabetes. o When dropped from the State Quest programs for Medicare/Medicaid there is no

direction on how to re-enroll.

Group 1


• 1/5 stay in North Shore for care

• Other places that participants seek care are (participants go to multiple providers, so the numbers add up to more than 5)

o Town (Honolulu) – 2 participants o Moanalua (Kaiser) – 1 participant o West Side (Waipahu/Ewa Beach) – 1 participant o Waianae Comp – 1 participant

• Participants requested that satellite clinic be set up, so providers could come once a week or once a month

• All of the participants reported that they see their physicians monthly for regular follow-up checks

• All of the participants reported that they only go to the dentist for treatment and that their insurance only covers extraction. One participant reported that she used to go for regular cleanings and check-ups when she worked and insurance covered them.

• 2/5 have HMSA Quest + Medicare

• 2/5 have Quest only

• 1/5 has Kaiser

• Main problems o Lack of educational opportunities o Homelessness o Lack of access to showers and clothes for homeless and poor o Lack of recreational sites o Risk of falls o Transportation - Waialua is far from everything (going to the doctor takes all day) o Lack of homemaking/chore services (many old and disabled cannot care for

themselves)


o Lack of nutrition

• Main desired services o Dental care o Nutrition o Job training/education o Transportation to health providers o Homemaking/chore services o Urgent care o Wound care o Someone to check on elderly o Gathering place/recreation o Exercise classes o TB clearance o BP checks o Diabetes checks

Group 2


• 2/8 seek care at Medical Arts in Wahiawa

• Other places that participants seek care are o Ewa Beach o Waipahu o Tripler o Waikiki CHC o Kaiser Permanente in Waipio o Palama Settlement

• One individual has been "Doctor Shopping" because he feels that the providers he has seen do not care for him as an individual, but just as a statistic. He feels that he is not "understood".

• Three individuals report that they can arrange for transportation for their appointments by calling two days in advance (service provided by Evercare or Wellcare). Others reported taking city transportation (the Bus) to their appointments, or to get the prescription medication refilled. For health issues outside of routine follow-up, the emergency room is utilized, usually via ambulance service.

• None had had preventive health care exams in the past year. They reported routine regular follow-up care for chronic health conditions.

• None had routine preventive dental care treatment. One proudly displayed her new dentures which she had to pay for as there were no co-payment options. All reported only extraction as an option for their dental care needs.

• None were able to verbalize any routine immunizations, such as flu shots.


• 3/8 Quest (Evercare)

• 1/8 Quest (Wellcare)

• 2/8 Tri-Care

• 2/8 individuals without any health insurance: o One of these individuals had previously had care through the State Quest

program, but failed to respond to a choice of providers as requested, and was dropped from the rolls. He is able to get care (indigent care) through the Veterans Ambulatory Care Clinic until he is able to be reinstated with the state Quest program.

o The second did not explain his circumstances for no health insurance coverage, and related that he had to seek care at another CHC (Waikiki) and was then referred to the Kahuku Hospital to see a physician.

• Main problems o Psychiatric or mental health issues o Doctors do not accept Medicare/Medicaid o Recovered substance abusers o Heart Disease o Hypertension o Hypercholesterolemia o Diabetes o Blindness o Deafness o Obesity

• Main desired services o Chronic disease management o Doctors who accept Medicare/Medicaid o Transportation o Jobs and job training o Homeless services o Drug abuse treatment o Recreational areas o Health Education o Immunizations o Mental health care o Nutrition

• Other comments/concerns o When a prescription is written for a 30 day supply, the pharmacy will only fill for

15-17 days, requiring a second trip to the Pharmacy and a second co-pay. o When a healthy diet is prescribed, the little money that is left for food is

inadequate to buy the fresh vegetables/fruits recommended for diabetes. o When dropped from the State Quest programs for Medicare/Medicaid there is no

direction on how to re-enroll.


Appendix D Wahiawa Community Health Center

Survey of Interest

Name: Email: Phone #: Resident of:

� Wahiawa � Mokuleia

� Helemano � North Shore

� Waialua � Mililani

� Haleiwa � Other: ___________________________

Affiliation (check all that apply):

� Community member � Business sector

� Young family � Government employee

� Senior � Social service/non-profit sector

� Disabled � Physician (specialty):_______________

� Potential health center patient � Healthcare provider other than physician

� Other: ____________________________ (specify): ________________________

� I am willing to participate in meetings to develop the responsibilities, concepts and other tasks to establish the board of directors of the Wahiawa Community Health Center.

� I am willing to contribute resources (meeting or office space, food for community meetings, volunteer time, etc…) that will help establish the Wahiawa Community Health Center, including: ________________________________________________________________

� I am willing to participate in a focus group regarding the health needs in the community (2 hour commitment).

� I want to be included in the needs assessment (written survey).

� I would like to be included on an email list to be informed of the activities to establish the new Wahiawa Community Health Center.

Source: Date:


Survey of Needs in Wahiawa and Surrounding Areas

Please list what you believe to be the top 5 health and/or social service PROBLEMS/NEEDS in the community: 1. 2. 3. 4. 5. Please list what you believe to be the top 5 health SERVICES needed in the community: 1. 2. 3. 4. 5. Comments:


Appendix E Wahiawa Center for Community Health

P.O. Box 30668

Honolulu, Hawaii 96820

Survey of Interest in Wahiawa and Surrounding Areas

Please check what you believe to be the top 5 health and/or social service PROBLEMS in the community:

� Affordable child care � Heart disease

� Asthma � Housing

� Chronic disease management � Jobs

� Cultural Issues � Mental health

� Diabetes � Obesity

� Disease prevention/health promotion � Recreation sites

� Doctors do not accept Medicare/Medicaid � Translation services

� Drug use � Transportation

� Education � Other: ___________________________

Please check what you believe to be the top 5 health SERVICES needed in the community:

� Care coordination services � Nutrition

� Case managers � OB/GYN

� Dental care � Orthopedics

� Health education � Primary care

� Health support groups � Social workers

� Immunizations � Transportation to health providers

� Job training/education � Other: ___________________________

� Mental health care

� I am willing to participate in meetings to develop the responsibilities, concepts and other tasks to establish the board of directors of the Wahiawa Center for Community Health.

� I am willing to contribute resources (meeting or office space, food for community meetings, volunteer time, etc…) that will help establish the Wahiawa Center for Community Health, including: ________________________________________________________________

� I am willing to participate in a small talk-story group regarding the health needs in the community (2 hour commitment).

� I want to be included in public outreach, wellness events or other community gatherings.

� I would like to be included on an email list to be informed of the activities to establish the new Wahiawa Center for Community Health.

(Please complete other side)


Wahiawa Center for Community Health

Survey of Interest in Wahiawa and Surrounding Areas

Resident of:

� Wahiawa � Haleiwa

� Helemano � Mokuleia

� Whitmore Village � Waialua

� North Shore � Other: ___________________________



� Young family � Union employee




� Other: ____________________________ (specify): ________________________

Comments:

Name: Email: Phone #:

Source: Date:


Appendix F Wahiawa Center for Community Health

P.O. Box 30668

Honolulu, Hawaii 96820

Survey of Healthcare Access in Wahiawa and Surrounding Areas Please check what you believe to be the top 5 health and/or social service PROBLEMS in the community:

� Affordable child care � Heart disease

� Asthma � Housing

� Chronic disease management � Jobs

� Cultural Issues � Mental health

� Diabetes � Obesity

� Disease prevention/health promotion � Recreation sites

� Doctors do not accept Medicare/Medicaid � Translation services

� Drug use � Transportation

� Education � Other: ___________________________

Please check what you believe to be the top 5 health SERVICES needed in the community:

� Care coordination services � Nutrition

� Case managers � OB/GYN

� Dental care � Orthopedics

� Health education � Primary care

� Health support groups � Social workers

� Immunizations � Transportation to health providers

� Job training/education � Other: ___________________________

� Mental health care

Resident of:

� Wahiawa � Haleiwa

� Helemano � Mokuleia

� Whitmore Village � Waialua

� North Shore � Other: ___________________________



� Young family � Union employee




� Other: ____________________________ (specify): ________________________


Survey of Healthcare Access in Wahiawa and Surrounding Areas Where do you go for medical care (check all that apply)?

� Wahiawa

� Mililani

� North Shore

� Town (Honolulu)

� Community Health Center � CareVan

� Kalihi-Palama Health Center

� Kokua Kalihi Valley Comprehensive Family Services(KKV)

� Ko’olauloa Community Health and Wellness Center

� Wai’anae Coast Comprehensive Health Center (Waianae Comp)

� Military facility (Tripler, Schofield, etc.)

� Other: ___________________________

When was your last visit to a doctor for a checkup or physical exam?

� Less than 1 yr

� 1 to 2 years ago


� More than 5 years ago

� Never

� Do not remember

When was the last time you visited a dentist or dental clinic?

� Less than 1 yr



� More than 5 years ago

� Never

� Do not remember

Do you have health insurance (check all that apply)?

� Medicaid

� Quest (Ohan � Medicare � Tricare

� Kaiser

� Other private (HMSA, HMA, UHA, etc.) � None


Appendix G

Dots is the gathering place in Wahiawa

(Scott Harada, owner of Dots, is a member of the board of the Wahiawa Center for Community Health)

Wahiawa United Methodist Church

Site of Wahiawa Center for Community Health board meetings (Pastor Fran Weibenga is a member of the board of the

Wahiawa Center for Community Health)

Planning team members, board members, and their families

visited Kukaniloko, a sacred site for Native Hawaiians for the birth of royalty, astronomical observation, and navigation eduction,

located right outside Wahiawa

wahiawa center for community health final report - wahiawā, waialua, mililani… · 2018-01-25 ·...

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