Date of Award
Spring 6-12-2026
Document Type
Dissertation
Degree Name
Ph.D. in Social Work
Organizational Unit
Graduate School of Social Work
First Advisor
Sophia Sarantakos
Second Advisor
Ramona Beltran
Third Advisor
Tyrone Hamler
Copyright Statement / License for Reuse
All Rights Reserved.
Keywords
Healthcare, Native Hawaiian women, Structural conditions, Intersectionality, Discrimination, Intervention
Abstract
The oppressive experiences of Indigenous women within healthcare settings remain underexplored in the literature, particularly regarding Native Hawaiian women. Existing research often treats women’s healthcare experiences as monolithic overlooking the historical, structural, and intersectional forces that shape them. For Native Hawaiian women, these include the enduring impacts of colonization, the illegal occupation of Hawai‘i, systemic and structural discrimination, and epistemic silencing within medical and institutional contexts. These structural conditions shape not only healthcare access and quality but also whose lives are valued, prioritized, and rendered disposable within clinical settings. This dissertation addresses these gaps through three interconnected manuscripts that progress from exploratory analysis to intervention development.
The first manuscript draws on Abolition Medicine (Iwai et al., 2020), Necropolitics (Mbembe, 2003), and Critical Indigenous Feminist frameworks (Crosschild, 2026) to develop a conceptual model, the Cycle of Healthcare Oppression. Using Hawaiian-style Talk Story sessions (Affonso, 2007), this study examines how Native Hawaiian women describe and interpret their healthcare experiences, as well as the structural and interpersonal factors shaping these encounters and subsequent health outcomes.
The second manuscript builds on this conceptual model and focuses on intersectional discrimination. Using a parallel convergent mixed-methods design, this study examines how experiences of discrimination over time are associated with anticipated discrimination among Native Hawaiian women. Findings demonstrate that intersectional discrimination operates through complex, non-linear patterns, with anticipated discrimination emerging from multiple sources beyond direct personal experience.
The third manuscript extends this work by transitioning from exploratory analysis to formative intervention development. Building on findings from the first manuscript, this study co-creates a relational Indigenous poetic intervention, Poetic Medicine, through Hawaiian-style Talk Story sessions (Affonso, 2007). Findings suggest that Native Hawaiian women are receptive to this intervention and indicate its potential to transform how healthcare experiences are understood and processed. This work further suggests that Indigenous poetic methods may help disrupt the Cycle of Healthcare Oppression by fostering relational meaning-making and collective reworlding.
Copyright Date
6-2026
Publication Statement
Copyright is held by the author. User is responsible for all copyright compliance.
Rights Holder
Kristina L. Hulama
Provenance
Received from ProQuest
File Format
application/pdf
Language
English (eng)
Extent
151 pgs
File Size
929 KB
Recommended Citation
Hulama, Kristina L., "Breaking the Cycle of Oppression in Healthcare with Poetic Medicine: A Mixed-methods Study" (2026). Electronic Theses and Dissertations. 2722.
https://digitalcommons.du.edu/etd/2722
Included in
Hawaiian Studies Commons, Indigenous Studies Commons, Medical Humanities Commons, Medicine and Health Commons, Race and Ethnicity Commons, Social Work Commons, Women's Studies Commons