Seeking health care: Marshallese migrants in Hawai'i.

OBJECTIVE The number of Marshallese migrants has dramatically increased in the US and its territories since the 1986 Compact of Free Association agreement. Their poor health status and patterns of untimely care are considered a great public concern in the host society. This paper examines the health care patterns of Marshallese migrants in Hawai'i and how their specific characteristics and circumstances affect their behaviors when seeking health care services. DESIGN In-depth interviews were conducted with Marshallese migrants, key informants in the Marshallese community, and health and social service providers in the local community. RESULTS This study reveals three important patterns of health care seeking behavior among Marshallese migrants. First, Marshallese migrants do not seek health care until they perceive a health crisis, usually indicated by pain. This cultural notion of 'present crisis-oriented health care' governs overall health care behaviors of Marshallese migrants. Second, Marshallese migrants are highly reliant on parochial networks for health care, given the strong mutual trust and the value assigned to interdependency within their culture. Despite many benefits of these networks, heavy dependence on them results in failure to obtain timely care when network resources become inaccessible or unavailable. Last, Marshallese migrants in Hawai'i do not rely on traditional health care practices as much as on the allopathic health care system. Their health care depends heavily on curative and tertiary care and health care assistance in the public sector. CONCLUSION Health care seeking behaviors of migrants are shaped by cultural definition of health and health care and macro-social factors such as characteristics of the co-ethnic community and social networks, the health care system, and health policies, in addition to individual's socioeconomic status. These findings have important implications for community health care practices and policies.