Building Strong Foundations for Community-Driven Health Research

The American Indian, Alaska Native, Native Hawaiian, and Pacific Islander (AI/AN NHPI) Enrichment Initiative was launched in March 2024 under the NIH Community Engagement Alliance to address differences in health outcomes among Indigenous communities. The initiative emphasizes community-driven, scientifically rigorous, intervention-based research that reflects cultural values and priorities. 

Centering cultural knowledge and maintaining roots in the values of relationship-building and connectedness to people, land, and all beings, the communities participating in this initiative bring powerful strengths that guide their approaches to health and wellbeing. These strengths provide a foundation for addressing chronic conditions such as diabetes and heart disease, conditions that are shaped by historical factors that have contributed to food and nutrition insecurity and limited access to healthcare. By elevating community leadership, honoring Tribal sovereignty, and co-creating culturally grounded strategies, the program aims to build on each community’s inherent strengths to foster healthier, more resilient communities. 

Phase I: Building Foundations and Piloting Solutions

From 2024–2025, three awardee institutions focused on adapting and pilot-testing interventions designed to improve health outcomes:

University of Hawai‘i at Mānoa (UHM) partnered with the National Association of Pasifika Organizations and Papa Ola Lōkahi to implement the PILI Pasifika Program (PPP), an NHPI cultural adaptation of the National Diabetes Prevention Program. Delivered by 24 trained community health workers (CHWs) across 15 community sites, PPP enrolled over 240 participants. Results showed improvements in cardiometabolic health indicators, including weight, blood pressure, HbA1c, total cholesterol, and low-density lipoprotein cholesterol. Participants also experienced significant improvements in social and behavioral determinants of health, including fruit and vegetable consumption, physical activity, food literacy, social support, housing stability, and overall well-being. The team also developed a comprehensive CHW training program and translated social determinants of health measures into Chuukese, Marshallese, Sāmoan, and Tongan to enhance cultural and linguistic accessibility across Pacific Islander communities.

One CHW shared how the program transformed the life of a participant and her family. “When I first told her about the program she was hesitant. When I got her into the program there was a light that shined from within her that wasn’t there before. She had been closed off from everyone for more than 2 and a half years. The program brought her out of depression and she set goals for herself and blew those goals out of the park. She uses a walker and by the end of the program she was walking without her walker. She joined hula for health classes and was smiling ear to ear. This program really improved her quality of life and brought her pure happiness. Her family is grateful because this program made her happy during the last year of her life. Aunty Fua’s family is deeply grateful for this program that brought Aunty Fua happiness in the last months of her earthly life. Aunty Fua’s brother is now set to join our next cohort and we know Aunty Fua is cheering him on from heaven.” - Cynthia C, Community Health Worker.

University of Alaska Fairbanks (UAF) partnered with Yup’ik Alaska Native communities in the Yukon-Kuskokwim Delta to adapt and pilot the Qungasvik (Toolbox)-Healthy Hearts intervention. This culturally - grounded and community-driven intervention promotes healthy traditional activities such as hunting, fishing and gathering and strengths intergenerational connections between young people and older adults and Elders. The pilot engaged 285 individuals in the community in the study. Findings demonstrated improvements in blood pressure, physical activity, and psychological well-being, reinforcing the value of culturally rooted approaches in the promotion of cardiovascular and cerebrovascular health.

“Nerangnaqsaraq  is the wholesome ways of gathering and preparing traditional Yupik food. Spirituality, cultural compassion, and action in healthcare go hand in hand. Yupiit practice healthy activities while catching and processing salmon.”  -Ay’qulluk Jim Chaliak, UAF Co- Investigator 

Johns Hopkins University (JHU) adapted and piloted Together Overcoming Diabetes for Lakota family dyads in South Dakota. Through focus groups and the incorporation of Lakota language and cultural elements into the curriculum, the team enrolled 40 adult/youth dyads.

Early feedback indicates strong engagement and enthusiasm for the family-based model, with promising trends in health outcomes. Preliminary results show improved blood pressure among adults and youth. Adult results demonstrated reductions in diabetes distress and youth results revealed reduced sugar-sweetened beverage intake. 

Across all sites, teams strengthened community partnerships by actively involving community members and leaders across all aspects of the study to support the intervention delivery, forming a strong foundation for future expansion.

The next phase will build on these foundations by strengthening rigor, enhancing reproducibility, and intentionally integrating implementation science approaches across all teams to support consistent, effective, and scalable intervention delivery. By continuing to prioritize cultural alignment and community-led methods, the initiative aims to deepen its impact while advancing sustainable, evidence-informed solutions.

This initiative highlights the value of culturally aligned, community-driven, and collaborative efforts to improve health through approaches that respect and reflect the voices of Indigenous communities. By centering cultural knowledge and fostering trust, the AI/AN NHPI Enrichment Initiative is paving the way for healthier, stronger communities.