As a native Hawaiian, Lisa Kaneshiro, PsyD, sees her fellow islanders grapple with more than their share of health problems: high rates of diabetes, obesity, elevated blood pressure and new cases of HIV. Native Hawaiians, in fact, have the shortest life expectancy of any group in the state. And perhaps not surprisingly, they also report high levels of depression, anxiety and other mental disorders.

With an eye toward addressing such disparities, Kaneshiro enrolled in a doctoral program at Argosy University/Honolulu, where she specialized in health psychology. Today, Kaneshiro works as the only psychologist in a group of community health centers known as The Bay Clinic, located on the Big Island. In this capacity, she contributes to the clinic's mission to provide integrated, culturally competent health-care services to underserved residents. Kaneshiro, drawing on her knowledge of psychology as well as native Hawaiian culture, consults with a team of medical professionals who provide services spanning from alleviating colds to settling anxieties, regardless of the patients' ability to pay.

Though the pay is less than what many clinicians would receive in private practice, Kaneshiro appreciates the stability of the job as well as the opportunity to aid fellow Hawaiians.

"We have a tough community with a lot of problems," Kaneshiro says. "When I can be on their journey of getting better--that is just an incredible honor for me."

Helping to heal

Kaneshiro sees up to 14 people a day across three different clinics, but the chance to help people overcome complex problems such as obesity--which affects up to 65 percent of native Hawaiians--makes the long hours worth it, she says. The psychologist especially enjoys working alongside physicians, nurses, dentists and other health professionals to identify the multiple factors that contribute to patients' health problems--a rare opportunity for a psychologist in a community health setting, she says.

For example, when the clinic's nurse practitioners identify someone with dangerously high blood pressure, they may send the patient to Kaneshiro. She then helps such clients identify behaviors contributing to their unhealthy lifestyle--perhaps a lack of physical activity--and works with them to devise strategies for leading healthier lives.

The psychologist's knowledge of local culture often helps her to partner with clients to plan potential behavior change, Kaneshiro says. For example, by appreciating the role communal eating plays in Hawaiian culture, Kaneshiro knows not to suggest that clients sit out family feasts entirely.

Obesity is just one of the many issues Kaneshiro encounters on a given day. The psychologist also uses traditional cognitive-behavioral interventions to assist clients who are grappling with anxiety and depression. Additionally, Kaneshiro helps people learn to better manage chronic illnesses, such as diabetes. And soon Kaneshiro will launch a smoking-cessation program modeled on one developed by Tripler Army Medical Center in Honolulu.

Culturally appropriate care

In addition to experiencing diverse health problems, Kaneshiro's clients come from diverse cultures. The Bay Clinic, which is funded through both federal and private grants, serves a population including people of Chinese ancestry, Asian-Americans, Hispanics and, of course, indigenous Hawaiians. According to Devon Lee, a Bay Clinic intern, seeing someone who "looks like them," puts many native Hawaiians at ease.

"Lisa has the ability to blend traditional cognitive therapy and health psychology with cultural considerations," Lee says.

For example, Kaneshiro encourages clients to be assertive in their daily lives, while still adhering to the Hawaiian values of harmony and obedience, she says. When talking about family dynamics, the psychologist keeps in mind many Hawaiians' large and broadly defined extended families. And with some of her clients, Kaneshiro makes use of her knowledge of Hawaiian pidgin--a mixture of Hawaiian and English spoken by many native islanders.

"I try to work with them in a way that is respectful of cultural nuances, while still pulling them toward a healthy existence," she says.