An Exploratory Mixed Method Cross-sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program

Published:August 21, 2022DOI:



      Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations.


      1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students’ responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success.


      This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai‘i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community.


      Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed.


      Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council.


      Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need.


      Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.


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      M. K. Fialkowski is an associate professor, Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu.


      M. R. Sandlin is an academic professional associate, University of Georgia, Tifton, GA.


      J. Kai is a doctoral candidate, University of Hawaiʻi at Mānoa, Honolulu, HI.


      J. Ng-Osorio is a Native Hawaiian Culture Case Study Manager, Department of Psychiatry, Research Division, John A. Burns School of Medicine, University of Hawai`i at Mānoa, Honolulu, HI.


      R. C. Custodio is an associate professor of Health Science, University of Hawaiʻi West Oahu, Kapolei, HI.


      S. Ka‘iulani Odom is a Roots Program director, Kōkua Kalihi Valley Comprehensive Family Services, Honolulu, HI.


      J. K. Boyd is a professor, University of Hawaiʻi, Windward Community College, Kāneʻohe, Hawaiʻi.


      C. Medina is a registered dietitian nutritionist, Community Living Center (CLC), VA Pacific Islands Healthcare System, Honolulu, HI.


      D. Takahashi is an individualized supervised practice pathway intern, University of Hawaiʻi at Mānoa.


      M. K. Esquivel is an associate professor and Dietetics Program director, Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, Honolulu, HI.