title: Assessing health disparities in rural Hawaii using the Hoshin facilitation method.
abstract: BACKGROUND
  Health disparities between rural and urban communities are well documented. There are many suggested causes and many proposed solutions but no one-size-fits-all answer. The most successful community interventions have been introduced by communities themselves. However, before communities invest in such interventions, each group must identify and prioritize their needs.
  
  
  OBJECTIVE
  This article describes the Hoshin facilitation method as a practical option assisting communities in assessing their needs and gaining consensus for future steps.
  
  
  METHODS
  Thirty-four meetings were held in 11 rural communities in Hawaii using the Hoshin process to identify factors that impact rural health. Themes were identified by constant comparative analysis and thematic frequency described. Commonality of responses between communities was examined. Informal feedback was collected from meeting participants.
  
  
  RESULTS
  There was a great deal of commonality between community responses, with economic factors, drug use, lack of community leadership, lack of health care services and access to services, lack of healthy activities for youth, and poor public education being the most common issues noted. Group involvement in the meetings was high, and the facilitation method received positive feedback from participants.
  
  
  CONCLUSIONS
  The Hoshin facilitation method is a very useful tool to help communities rapidly identify and prioritize areas for programmatic attention.
authors.affiliation: Hawai'i/Pacific Basin Area Health Education Center, University of Hawai'i, Honolulu, Hawai'i 96813, USA. withyk@hawaii.rr.com
authors.forename: Kelley
authors.initials: K
authors.lastname: Withy
authors.forename: January May
authors.initials: JM
authors.lastname: Andaya
authors.forename: Judith S
authors.initials: JS
authors.lastname: Mikami
authors.forename: Seiji
authors.initials: S
authors.lastname: Yamada
mesh_terms: D018672:Community Health Planning / Q000379:methods / Q000458:organization & administration*; D003256:Community Participation; D032921:Consensus; D005260:Female; D006126:Group Processes; D006254:Hawaii; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008297:Male; D017146:Models, Organizational; D020380:Needs Assessment / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D012959:Socioeconomic Factors