Intersectional Discrimination, Epistemic Injustice, and Medical Gaslighting: A Scoping Review

Native Hawaiians and Pacific Islanders (NHPIs) face significant health disparities, including elevated rates of chronic illness, disability, and premature mortality. Research by Native Hawaiian scholars have highlighted how these disparities are closely linked to systemic racism and discrimination. However, limited attention has been paid to how intersectional discrimination and other forms of systemic discrimination like epistemic injustice and medical gaslighting contribute to these inequities. This scoping review examines existing literature to explore how NHPI experiences—particularly those of women—are shaped by these interlocking forms of oppression. The objective is to map the current knowledge base and identify gaps to inform more equitable, culturally responsive healthcare practices and policies for NHPI communities.The research question is: In studies examining experiences of epistemic injustice, medical gaslighting, and intersectional discrimination, what has been documented by this population?

This scoping review was conducted following the methodological framework proposed by Arksey and O’Malley (2005) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to ensure a systematic and transparent process. A comprehensive search strategy was developed using Boolean operators across four electronic databases, incorporating key terms related to women, Native Hawaiians, Pacific Islanders, discrimination, epistemic injustice, and medical gaslighting. Studies were eligible for inclusion if they focused on adult Native Hawaiian and Other Pacific Islander women and reported their experiences as patients, particularly in relation to healthcare provider interactions involving self-reported discrimination, epistemic injustice, or medical gaslighting. Articles meeting the inclusion criteria were subjected to full-text review and analyzed in alignment with the central research question.

The database search yielded 708 articles, of which only two met the inclusion criteria for full-text review. Both studies employed community-based participatory research and qualitative focus group methodologies to examine the healthcare experiences of Native Hawaiian and Marshallese women. Findings revealed recurring themes of cultural insensitivity, disrespectful treatment, and structural barriers—particularly language inaccessibility—which collectively discouraged continued engagement with healthcare services. One study identified language as a significant barrier to prenatal care among Marshallese women, while the other highlighted cultural disrespect toward Native Hawaiian kūpuna (elders). These experiences contributed to feelings of shame, mistrust, and healthcare avoidance, thereby reinforcing health disparities. Importantly, no studies explicitly addressed medical gaslighting, revealing a critical gap in the literature and underscoring the need for further research into the healthcare experiences of NHPI women.

This scoping review highlights a critical gap in the literature concerning intersectional discrimination, epistemic injustice, and medical gaslighting experienced by Native Hawaiian and Other Pacific Islander women. The findings suggest that harmful patient-provider interactions have both individual and community-level consequences, including healthcare avoidance and worsened health outcomes. When women feel dismissed or disrespected by providers, they are less likely to seek care, especially preventive services. This review underscores the urgent need for research that examines the relationship between discrimination, epistemic harm, and healthcare engagement. Future studies must center Indigenous women’s voices to address systemic inequities and improve culturally responsive care.