Ku Like Kakou: Utilizing a Community-led Model of Collaboration to Respond to the COVID-19 Pandemic.

The outbreak of COVID-19 in 2020 brought significant challenges for Native Hawaiians (NH), Pacific Islanders (PI), and other communities of color worldwide. Rapidly increasing rates of infection and transmission of the virus in Native Hawaiian and Pacific Islander (NHPI) communities and incomplete or unavailable data signaled to Hawai'i's leaders that advocacy and action needed to take place to minimize the impact of COVID-19. The Native Hawaiian and Pacific Islander Response, Recovery, and Resilience team (NHPI 3R Team) emerged from an effort to lead and fill gaps in response to COVID-19. Through the swift, intentional, and collaborative work of the team and its partners, NHPI communities and the entities that serve them were better equipped to navigate the pandemic, improve health outcomes, and contribute to a reduction in the number of infections, a rise in vaccination uptake, and an increase in NH and PI representation on various levels of government agencies. As the world shifts its focus from COVID-19 to broader health topics, the NHPI 3R Team will continue to serve as a hub for the exchange of resources and a model of community-led work that can be used to tackle issues like COVID-19 and beyond.

Ho'oilina Pono A'e: Integrating Native Hawaiian Healing to Create a Just Legacy for the Next Generation.

Native healing practitioners have been incorporated into health centers serving large populations of Kanaka 'Oiwi (Native Hawaiians). However, no studies have examined their impact. A community based participatory research study at Waimanalo Health Center from 2017 to 2019 examined the added value of integrating native healing practices into primary care, including whether there is acceptability of the integration, cultural connectedness due to integration, and empowerment for patients, providers, and staff. Semi-structured interviews were conducted by the research team with 24 patients, providers and staff, and community residents. Through content analysis, 5 themes emerged. The integration of native healing practices provides an alternative to western medicine, recalls ancestral knowledge, focuses on the whole person, generates increased disclosure leading to behavior change, and is central to a decolonizing process. The findings support the integration of native healing practices providing added value in primary care.

Engaging Community Health Centers to understand their perceptions and interest in longitudinal cohort research on diabetes mellitus in Native Hawaiian communities: Initial insights from the Waimanalo community.

Introduction: Despite decades of research on diabetes mellitus (DM) and other health disparities affecting Native Hawaiian and Pacific Islander (NHPI) populations, little is known about the disease mechanisms that underlie these health disparities. Ideally, a longitudinal cohort study is one of the best research design tools to examine underlying mechanisms of disease in health disparity conditions such as DM. The study purpose is to understand the perspectives and insights of people (n = 29) living in NHPI communities about conducting longitudinal cohort studies aimed at understanding mechanisms of health disparities in NHPI populations. Methods: All interviews were audio-recorded, transcribed and de-identified into written transcripts for thematic content analysis. Results: Four major themes emerged: 1) Diabetes and other health disparities is a community priority because these diseases touch nearly everyone; 2) Cohort-type research and its outcomes should extend beyond data collection to include data sharing using a cultural context approach; 3) Cohort-type research can directly benefit everyone, especially youth, through education on new, locally-derived knowledge; 4) A longterm benefit of cohort-type research should be to support "generational change" in the community. Discussion: In summary, potential "cohort-type research" (a.k.a. longitudinal cohort study designs) was perceived as a worthy endeavor because health disparities, such as DM, affects nearly everyone in the community. Cohort-type research is important to NHPI communities as it holds promise for impacting "generational change" on health and wellbeing through the sharing of new community-derived knowledge.

Building the Beloved Community: Reflections in Understanding Relationships to Food for Native Hawaiians.

INTRODUCTION: Health disparities within the Native Hawaiian community have been well-documented for many years. METHODS: Innovative, culturally relevant, and community-generated approaches are required to truly change the trajectory and impact of chronic illnesses for Native Hawaiians. This article describes the experiences of residents from Wai'anae and Waimanalo who were trained in a process called Building the Beloved Community, and facilitated group sessions for a community-based participatory research (CBPR) project around 'ai pono (eating healthy), seeking to understand Native Hawaiian community residents' perceptions of current and historical influences on eating. Community facilitators and observers engaged 40 residents to better understand peoples' life experiences around food. RESULTS: The community facilitators identified key principles derived from their training and facilitation experience, important elements for effective discussion circles, and the transformative outcomes experienced by all involved. CONCLUSIONS: By sharing these experiences, they hope to encourage use of a similar process to promote lifestyle changes in communities.

Connecting culturally and spiritually to healthy eating: A community assessment with Native Hawaiians.

Many of the chronic illnesses disproportionately experienced by Native Hawaiians are directly related to poor diets and long-standing obesity beginning in childhood. We report on the findings of in-depth key informant interviews (N=14) that took place in two Native Hawaiian communities as part of a larger, community-based participatory research study that included a community assessment through individual interviews and focused group discussions, and a pilot intervention targeting pregnant women, their infants, and families. Four categories emerged from the qualitative analysis of interview transcripts that described an understanding of "healthy eating": family roles and responsibilities, aspects of community and physical environment, deeper spiritual meaning of food, and ways of operationalizing personal eating choices. The findings revealed previously undocumented intergenerational influences on healthy eating patterns and informed the design of the next study phases and are of significance in targeting nutritional interventions for Native Hawaiians.

Engaging Native Hawaiians and Pilipinos in creating supportive and safe violence-free communities for women through a piloted "talkstory" intervention: Implications for program development.

In Hawaii, 20% of women have been victims of intimate partner violence (IPV). Although disaggregated data specific to Native Hawaiians or Pilipinos (The official Filipino language recognizes both Filipino (Filipina) and Pilipino (Pilipina) as terms for the citizens of the country. Participants in this study chose to use the terms Pilipino (Pilipina). Retrieved from: www.pilipino-express.com/history-a-culture/in-other-words) are limited, greater than 70% of women murdered in Hawaii as a result of IPV are Pilipino or native Hawaiian. A consortium was formed to assist Native Hawaiian and Pilipino women addressing abuse and strengthening support from the community. A quasi-experimental community-based participatory research study was designed to assess a community "talkstory" intervention for IPV. "Talkstory" refers to informal gatherings considered to be a laid-back conversation involving a "reciprocal exchange of thoughts, ideas, feelings about self, and other issues" (Affonso et al., 1996. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25, 738). This article describes the development of an intervention to address IPV in Hawaii and presents the findings obtained from the pilot studies. Results from the pilot study were used to modify the proposed "talkstory" intervention, revise the data collection tools, and provide the program developers with insights into how the community viewed IPV. The most significant change was an increased perception of their awareness, knowledge, and confidence to address IPV following the intervention.

Refining the research infrastructure at community health centers.

BACKGROUND: Community health centers (CHC) often partner with academics to conduct community-based participatory research (CBPR). Because of their research expertise, academic partners are usually the principal investigators (PIs); however, moving the home base of research to the community can prove beneficial to the CHC and its community. OBJECTIVES: The purpose of this paper was to discuss the lessons learned after conducting a CBPR project and to share identified solutions. METHODS: A longitudinal perinatal risk reduction intervention study was conducted with primiparous Native Hawaiian women receiving prenatal care at a CHC. The intervention incorporated home visiting, social support, and lactation management. RESULTS: Primary lessons learned from this participatory process can be grouped into infrastructure, human resources, and recruitment. CONCLUSIONS: Sharing lessons learned can serve to expand a CHC's involvement in research, and provide a venue for discovering innovative and viable community and practice based approaches to solving health disparity challenges.

A Socioecological Predication Model of Posttraumatic Stress Disorder in Low-Income, High-Risk Prenatal Native Hawaiian/Pacific Islander Women.

INTRODUCTION: Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI. METHODS: A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD. RESULTS: Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level). DISCUSSION: Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.

Responding to the needs of culturally diverse women who experience intimate partner violence.

This paper presents the findings from a community based participatory research (CBPR) study that investigated the interface between culture and intimate partner violence (IPV) for women in selected cultural groups in Hawaii: Native Hawaiian, Filipino, Samoan, and Chuukese. The research question was, "What are the cultural perceptions, responses, and needs regarding IPV of selected individuals and groups served through a variety of programs that are affiliated with the three participating Community Health Centers (CHCs)?" This cross sectional, descriptive study collected both qualitative and quantitative data. Individual interviews were conducted with women who had experienced IPV. Focus groups were also conducted with other women from the same culture. Five common themes were identified across the four cultural groups: Living within a Collective; Cultural Protective Factors; Cultural Barriers to Helpseeking; Gender Specific Roles; and Belonging to a Place. The outcome from this study is increased knowledge that will be used to develop culturally appropriate interventions. Specific findings from each cultural group have been published. The purpose of this paper is to present common perceptions and responses to IPV from the four groups and suggest interventions based on the findings. Implications for practice are presented.

Intimate partner violence: systematic review of literature focused on the cultures of Hawai'i.

Although research on intimate partner violence (IPV) categorizes populations broadly; there is great diversity within the broad categories of Asian and Pacific Islanders. This paper reviewed the literature published between 1996 and 2005 focused on the intersection of IPV and culture within specific cultures in the State of Hawai'i. The current research literature related to IPV against women and these specific populations is summarized.

Breastfeeding patterns in a community of Native Hawaiian mothers participating in WIC.

Although Hawaii has high breastfeeding initiation rates (89%), Native Hawaiian WIC participants have much lower initiation (64%) rates. Little is known about why these disparities occur. The study's aim was to describe the breastfeeding patterns of Hawaiian/part-Hawaiian women enrolled in the WIC who had initiated breastfeeding. Retrospective descriptive data (N=200) were gathered from WIC records. Descriptive and parametric statistics with univariate and multivariate analysis of breastfeeding patterns were completed. Mothers exclusively breastfeeding at initiation weaned significantly later and were significantly more likely to breastfeed for 6 months than were mothers who partially breastfed. Practice and policy implications of these findings are discussed.

Finding solutions to challenges faced in community-based participatory research between academic and community organizations.

Partnerships between communities and academic institutions have been vital in addressing complex health and psychosocial issues faced by culturally diverse and hard-to-reach populations. Community-based participatory research (CBPR) has been suggested as a strategy to develop trust and build on the strengths of partners from various settings to address significant health issues, particularly those persistent health issues that reveal disparities among minority populations. There have been many challenges to developing these partnerships in the United States. The purpose of this paper is to discuss approaches and solutions used by this research team in response to the challenges they have faced in using CBPR. The team uses CBPR to understand and support the process of disclosure of intimate partner violence (IPV) within the context of the community health centers that provide services for multicultural and multi-lingual populations. While CBPR provides a route to develop trust and build on the strengths of partners from various settings, there are multiple challenges that arise when partnering organizations present with different infrastructures, missions, resources and populations served. Examples of common challenges and solutions from the literature and from the team's experience will be discussed. Implications for partners, partnerships, practice and research will be explored.

Intimate-partner violence: a retrospective review of records in primary care settings.

PURPOSE: The goals of this study were (a) to gather data regarding the documentation of disclosure of battering in primary care settings and (b) to collect demographic data, including ethnicity, of women who disclose intimate partner violence (IPV) in primary care settings in Hawaii. DATA SOURCES: We conducted a retrospective chart review focusing on documentation of IPV in four community health centers on Oahu. The review included 337 charts. The data were analyzed using descriptive statistics. CONCLUSIONS: Of the 337 records reviewed, IPV was reported in 31 (9.1%). Documentation of reported IPV differed among members of the various ethnic groups seen in the clinics. IMPLICATIONS FOR PRACTICE: Practitioners should develop a common area for documenting reports of IPV. The level and depth of resources available within the setting and the community may affect providers' willingness to screen for IPV.

The 'place' of data.

Health disparities research has been at the forefront for many researchers, organizations, and funding agencies. Collecting, interpreting, and disseminating data on particular disparate populations are at the core of this research process, data which have been interpreted to be meaningful to the benefit of and use by communities. The purpose of this paper is to explore the question, "How is data used?" with an appreciation for indigenous beliefs and community based research. An analogy, from the perspective of "place," will be used to illustrate how data is used through various levels of commitment or belonging one has to a particular place. Recommendations on the collection, interpretation and dissemination of data from this perspective conclude this paper.

Re-examining community based research protocols.

The Waiànae community is challenged with multiple medical, psychosocial, geographic, and economic adversities, serving primarily indigenous peoples. This is also a community with distinct cultural and political strengths and a history of community activism. Much has been written from the perspective of academia or professional organizations regarding community-based research. The purpose of this article is to re-examine research guidelines previously developed over ten years ago through the Waianae Coast Comprehensive Health Center, and to address issues which continue to significantly impact on any research conducted in the community of Waiànae. The first issue this article will address pertains to access to conduct research through this Center Next, the process for submitting a research proposal, and key community elements essential in research proposals will be described, followed by a discussion on "ownership" of data. An examination of the challenges discovered through research partnerships will conclude this article.