Conversation with Dr. Margaret Hattori-Uchima, School of Health, University of Guam

Advancing Cardiometabolic Health Equity for Pacific Islander Communities

Meet Margaret Hattori-Uchima, Ph.D., RN, FAAN, principal investigator in minority health and health disparities research.

Margaret Hattori-Uchima, Ph.D., RN, FAAN, is the Dean of the University of Guam School of Health and the contact Principal Investigator for the NIMHD U24 project, “A Cohort for Studying the Burden of Cardiometabolic Diseases in Guam and Pohnpei.” Her professional and academic collaborations target:

• Capacity building and research in health disparities.
• Elder care, with emphasis on the needs of patients and families coping with Alzheimer's disease.
• Cancer disparities.
• The biomedical training of underrepresented students in Micronesia.

As a nurse, researcher, and educator, Dr. Hattori-Uchima has listened to the pain and fear of patients who have endured inequities in health care. These experiences have inspired her to anchor her work in the concepts of compassion and social justice.

She has provided leadership in the study and alleviation of health disparities and had a significant impact in the arenas of education, practice, and health care. She developed a partnership with the Guam Homeless Coalition, and now, for more than a decade, continues to engage her students in its work.

She has fostered regional health labor force development through service as a long-time faculty member, Interim Director, and now Dean of the School of Health. Dr. Hattori-Uchima secured significant funding from the Health Research and Services Administration for the Guam/Micronesia Geriatrics Workforce Enhancement Program, which aims to use workforce development, family and caregiver training, and enhancement of practice environments in community-based and institutional settings to fill gaps in care for the elderly and those with Alzheimer’s disease and related dementias.

She has worked extensively with disadvantaged communities in Guam, including migrants from the Freely Associated States (FAS) who suffer inequities in health, education, and socioeconomic status.

She earned her Ph.D. in nursing from Villanova University, her M.S. in nursing from the University of Phoenix, and her B.S. from University of Hawai‘i at Manoa. In 2020, she was inducted into the American Academy of Nursing as the first Nursing Fellow from Guam.

Q&A with Dr. Hattori-Uchima

What is your research goal, purpose and aim?
The NIMHD-funded study titled, “A Cohort for Studying the Burden of Cardiometabolic Diseases in Guam and Pohnpei,” also known as the Pacific Islands Cohort on Cardiometabolic Health (PICCAH), is the first epidemiologic study conducted on Guam and on the Micronesian island of Pohnpei. The purpose is to estimate the prevalence of diabetes mellitus and cardiovascular disease, as well as the presence of lifestyle factors that contribute to noncommunicable diseases among Pacific Islander children and adults living in Guam and Pohnpei, and to assess the relationship of those risk factors between children and their biological parents.

Data from this study will establish the baseline of a generational epidemiologic cohort with a focus on cardiometabolic risk on Guam and a pilot study in Pohnpei will allow us to better understand the extent of diabetes mellitus and cardiovascular conditions and related risk factors of those residing in the Unites States Affiliate Pacific Islands (USAPI) of Guam and Pohnpei.

Another objective of the study was to pilot test the Guam research strategy in Pohnpei. The goal is to help build research capacities on both islands, specifically working with the College of Micronesia national campus on Pohnpei. Results of this study will be used to inform future studies among USAPI populations.

How is your work advancing health equity? Are you seeing specific changes in particular communities or groups?
The PICCAH study is still in the process of analyzing the data. However, we have seen increasing research capacity and identification of challenges and strengths of conducting research in our Pacific Islander region. We are currently preparing manuscripts to share knowledge regarding recruitment, structural challenges, and cultural implications to inform future researchers.

We look forward to sharing our findings to advance health equity in the area of cardiometabolic health for Pacific Islander communities. Understanding social, cultural, historical, and environmental factors specific to our Pacific Islands is critical in working toward developing effective interventions and ending health disparities.

What inspired you to become a researcher in minority health, health disparities, and health equity?
My background in home health nursing in the mainland U.S. led me to witness firsthand the effects of health disparities and the impact of the inequities plaguing our U.S. health care system. As the only minority RN in a large health care agency, I was tasked with managing many of the clients from a range of minority backgrounds. The lack of health care worker diversity and lack of cultural competence created huge barriers for our clients.

When I returned home to the island of Guam in 2000, I began working with migrants from the Federated States of Micronesia and recognized the health disparities faced by Pacific Islander migrants on Guam and in the U.S. I am of Chamorro and Japanese descent and was spurred to action by the ongoing inequities that lead to health disparities faced by people from Asian and Pacific Islander communities in the United States.

Pacific Islander communities suffer from some of the highest mortality rates resulting from noncommunicable diseases (NCDs) in the world. Due to the epidemic of NCDs in the United States Affiliated Pacific Islands, a Regional State of Emergency was declared by the Pacific Island Health Officers Association in 2010. This epidemic continues to plague our Pacific Islander communities and in the USAPI, Pacific Islander communities face a dual burden of communicable diseases and NCDs. I firmly believe that through research and education, we can increase awareness of minority health and health disparities to eventually improve health outcomes for all people.

I must also share that I am inspired to work in minority health and advancing health equity through my lived experiences as a minority researcher/educator/nurse. I have also been inspired to act through hearing the pain and fear of clients who have faced inequities in health care. My work as a nurse is rooted in principles of caring and social justice. I firmly believe that those of us who can make a positive difference in the area of health equity are obligated to take action. I strive to bring a feeling of inclusivity to those who feel marginalized. Through research, education, and service, I know that our work in advancing health equity will result in positive outcomes for our nation and our world.

How do we encourage the next generation of scientists?
The next generation of scientists must be encouraged through mentorship, coaching, and education in research that includes a focus on health equity. Fostering research self-efficacy in our next generation involves early exposure to research in the undergraduate years.

I participate as the Guam lead Principal Investigator for the NIH Building Infrastructure Leading to Diversity, Enhancing Cross Disciplinary Infrastructure and Training at Oregon (BUILD EXITO) led by Dr. Carlos Crespo and Dr. Thomas Keller of Portland State University. Strong research mentoring of our undergraduate students includes provision of a research mentor, peer mentor, and career mentor. Students also participate in regular enrichment activities with faculty and staff, including journal clubs, life skills training, and lectures by other researchers working in the area of health disparities.

Through the BUILD EXITO program, our Guam scholars have experienced strong support and training opportunities such as working with research labs throughout their undergraduate education. Providing a wide range of educational opportunities, combined with strong mentoring and appropriate role models, are some key steps to take when encouraging our next generation of scientists. It is heartwarming to see the growth of our students and increased research self-efficacy and self-confidence.

The majority of our University of Guam (UOG) students are considered to be of minority status when they enter U.S. mainland universities for graduate education. The strong mentoring and research training they receive in our BUILD EXITO program have often been cited as major drivers of their success upon graduation from UOG.

Students often state that they benefit from the experiences shared by our local researchers, many of whom are from Pacific Islander communities and are also minorities in the world of U.S. research. An important perspective to impart upon our next generation of researchers is the commitment to work in advancing health equity. I share the work of health disparity researchers with our students, and encourage them to value equity and envision their role in the future.

What do you envision as the future of minority health, health disparities, and health equity research?
I believe the ongoing COVID-19 pandemic shed a greater light on the existence of health disparities and the impact upon the whole of society. The future is one in which research is more inclusive, with a continued emphasis on the global impact of continued health disparities. NIMHD has been extremely supportive of our Pacific Islander-focused research, and I believe the support will continue, leading to increased research activities and positive impacts on health equity.

Encouraging minority-led research and increasing collaborations among health disparity researchers will help us reach the goal of decreasing disparities and advancing equity. Research capacity will continue to grow, even in our remote Pacific Islands, leading to increased knowledge and interventions to improve health outcomes. The overall vision of NIMHD, to have an America in which all populations have an equal opportunity to live long, healthy, and productive lives, will be realized through our continued work advancing health equity. I believe that in my lifetime, I will see significant advances in health equity and am grateful to the NIH and all the scientists who continue to pave the way toward an equitable future for all.

Page updated May 5, 2022