Exploring perspectives and insights of experienced voyagers on human health and Polynesian oceanic voyaging: A qualitative study.

BACKGROUND: The Worldwide Voyage (WWV) was a 3-year (2014-2017) open-ocean voyage to circumnavigate the world using Indigenous knowledge and navigational skills aboard Hokule'a, a traditionally designed Native Hawaiian (NH) voyaging canoe (wa'a kaulua). Each WWV segment included experienced crew and leadership who were recognized by their voyaging peers as highly experienced in Polynesian oceanic voyaging. This study explored the perceptions and insights of WWV-experienced ocean voyagers on the interconnection between human health and oceanic voyaging. METHODOLOGY: A constructivist approach with a storytelling-based moderator guide was used to conduct focus groups and informant interviews of experienced crew and voyaging leadership. Participants were interviewed and recorded transcripts were analyzed using content analysis. Triangulation of analysis included secondary thematic review by two independent NH cultural practitioners and participant member checking. Purposive sampling was used to enroll 34 of 66 eligible highly experienced voyagers (leadership n = 6; crew n = 28) in 5 focus groups and 4 informant interviews. RESULTS: Six themes emerged: 1) Indigenous context (spiritual and natural environment); 2) Importance of relationships and community; 3) Description of life on the canoe; 4) Holistic health; 5) Mindfulness, stress reduction and emotional health; and 6) Opportunities for intervention. Themes 1-5 were inductive and intricately interrelated, and theme 6 was deductive in that it directly resulted from a moderator guide question. Theme 6 offers strategies to improve the impact of voyaging and health well beyond the physical voyage with recommendations for improved transition back to land and developing a wa'a community context, which reflects a traditional voyaging experience. CONCLUSIONS: Polynesian oceanic voyaging is strongly perceived as a positive and transformative holistic-health-promoting experience. SIGNIFICANCE: Recommendations to promote generalizable health benefits of a voyaging lifestyle offers a promising and culturally grounded approach warranting future studies to understand mechanism and potential impact for improving health inequities.

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward.

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs' cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

A Qualitative Study on Preventing Gestational Diabetes in Native Hawaiian and Pacific Islander Adolescent Females: Perspectives from an Expert Panel of Health Care Providers.

The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai'i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities.

Qualitative study on voyaging and health: perspectives and insights from the medical officers during the Worldwide Voyage.

OBJECTIVE: To examine the potential association of ocean voyaging with human health and well-being from the perspectives and experiences of the medical officers (MOs) who served during the Worldwide Voyage (WWV). DESIGN: Using a phenomenology framework, focus group and individual interviews were conducted and analysed by three diverse core researchers and then reviewed by three external researchers to enhance triangulation. Analysis used the Framework Method and Atlas-ti software (V.8.4.4) to facilitate coding, identify categories and develop an analytical matrix. The matrix was applied to all data using the constant comparative method to construct major themes and subthemes. Synthesised member checking was performed. SETTING: In 2014-2017, the WWV began in Hawai'i on a traditional voyaging canoe, known as Hokule'a, using a non-instrument navigational method, 'wayfinding', powered only by natural forces and guided by traditional ecological knowledge. Each segment of the voyage included ~12 individuals, including an MO physician. The entire WWV included 172 ports-of-call, 36 legs and 250+ crew members. PARTICIPANTS: We purposively sampled all MO physicians who participated in the WWV and enrolled 87% of eligible MOs (n=20 of 23). We conducted two focus groups (n=17=11+6, 85%) and three individual informant interviews (n=3, 15%). RESULTS: The four major themes: (1) Relationships; (2) Preventive Care to Enhance Health; (3) Holistic Health and Wellbeing beyond Voyaging and (4) Spiritual Transformative Experience, strongly suggest that ocean voyaging aboard a traditional voyaging canoe enhanced human health and well-being. The overall impact to perceived health and well-being extended beyond any increase in physical exercise. Essentially, traditional Polynesian ocean voyaging provided a cultural-based context for holistic health and well-being that influenced multiple levels and multiple dimensions. CONCLUSION: Polynesian ocean voyaging was perceived as positively associated with holistic health and overall well-being and it may offer a new approach to confront complex health disparities.