Native Hawaiian/Pacific Islander Community Program Tackles Social, Health Needs

In the United States and U.S.-Affiliated Pacific Islands, many Native Hawaiian/Pacific Islander (NHPI) communities face social challenges that affect their health. In areas where access to sufficient medical care, income, and healthy foods has been compromised, higher rates of chronic disease often follow suit. Indeed, NHPI people experience more obesity, hypertension, type 2 diabetes, and cardiovascular disease than the general U.S. population.

Research shows that culturally tailored lifestyle interventions delivered by trusted community health workers (CHWs) have led to health improvements in NHPI people. Yet no research has studied the impact of addressing social concerns within these same interventions. Researchers from CEAL’s American Indian, Alaska Native, Native Hawaiian, and Pacific Islander (AI/AN NHPI) Enrichment Initiative set out to study both the feasibility and impact of doing so.

Twenty-four CHWs from the Pacific Islands, the continental U.S., and Hawaii recruited more than 240 NHPI participants to take part in an intervention co-developed by NHPI leaders and CHWs. The intervention, called the PILI Pasifika Program (PPP), enhanced an NHPI-adapted version of the Diabetes Prevention Program’s lifestyle intervention by addressing social factors. Participants attended weekly sessions at which CHWs provided workbooks and homework on diet, heart health, and physical activity. Attendees also received guidance and resources on food access, employment, housing, and legal issues.

The researchers’ findings

• After 3 months of the PPP intervention, the participants saw weight loss and low blood sugar levels, blood pressure, and cholesterol compared to the control group.
• They also showed increases in fruit and vegetable consumption, physical activity, food literacy, social support, housing stability, and overall well-being.
• In terms of feasibility, the CHWs and participants found the intervention to be culturally relevant, flexible, and adaptable to local contexts.

The evidence-based opportunities

• The PPP intervention is an example of CHWs effectively addressing health behaviors in the context of social challenges, resulting in meaningful behavior change and better clinical outcomes.
• CHW-led interventions delivered in a group setting have the potential to lower costs and enhance scalability, making them more sustainable over time.
• Participants and CHWs alike expressed satisfaction with the intervention, pointing to a promising model of a culturally tailored intervention that could be implemented across a range of NHPI communities.