Compliance by Samoans in Hawaii with Service Norms in Pediatric Primary Care

American Samoans are one in a number of Pacific Basin groups for which the U.S. Government provides health care assistance and one in a large number of recent immigrant groups to the United States. Although these groups often have health care beliefs inconsistent with Western primary care, their compliance with basic provider expectations (such as appointment keeping and appropriate emergency room use) remains largely unstudied. In the case of Samoans in Hawaii, concern is often expressed that a group much in need of health care (pediatric hospitalization and acute illness visit rates are high) often seems "out-of-sync" with Western health care. Four measures of noncompliance were studied in the Hawaii pediatric primary care residency training program. Enrolled Samoan patients were compared with an aggregation of more established ethnic groups. Four matched case-control studies controlled for socioeconomic status and the presence or absence of medical insurance and a home telephone. Samoans were more likely than the comparison group to miss health maintenance appointments, to drop in without an appointment, and to use the emergency room for nonurgent problems when a same-day-notice clinic visit would have usually sufficed.