Best practices for community-engaged participatory research with Pacific Islander communities in the USA and USAPI: protocol for a scoping review

Perceived Barriers and Benefits of COVID-19 Testing among Pacific Islanders on Guam

Pacific Islanders residing in the U.S. Affiliated Pacific Islands have had among the highest COVID-19-associated morbidity and mortality rates in the U.S. To reduce this disparity, we conducted a study to increase the reach and uptake of COVID-19 testing in Guam. Participants, who completed a pre-survey on demographics, health status, history of COVID-19 testing and vaccination, access to COVID-19 testing, sources of COVID-19 information, and knowledge and attitudes towards COVID-19 test results and transmission, were invited to attend an online educational session about COVID-19 testing and transmission and to complete a post-survey. There were significant positive changes between pre- and post-survey in knowledge and perceptions about COVID-19 testing and transmission, but changes were not necessarily due to exposure to the educational session. Compared to CHamoru participants (n = 380), Other Micronesians (n = 90) were significantly less knowledgeable about COVID-19 transmission and testing, were significantly more likely to not want to know if they had COVID-19, were more likely to believe if they did have COVID-19 there was not much that could be done for them, and that they would have difficulty in getting the needed healthcare. This study is another example of disparities in health knowledge and perceptions of certain Pacific Islander groups.

Global prevalence of preterm birth among Pacific Islanders: A systematic review and meta-analysis

The epidemiology of preterm birth among Pacific Islanders is minimally understood. The purpose of this study was to estimate pooled prevalence of preterm birth among Pacific Islanders and to estimate their risk of preterm birth compared to White/European women. We searched MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Library, CINAHL, Global Health, and two regional journals in March 2023. Observational studies were included if they reported preterm birth-related outcomes among Pacific Islanders. Random-effects models were used to estimate the pooled prevalence of preterm birth with 95% confidence interval (CI). Bayes meta-analysis was conducted to estimate pooled odds ratios (OR) with 95% highest posterior density intervals (HPDI). The Joanna Briggs Institute checklists were used for risk of bias assessment. We estimated preterm birth prevalence among Pacific Islanders in the United States (US, 11.8%, sample size [SS] = 209,930, 95% CI 10.8%-12.8%), the US-Affiliated Pacific Islands (USAPI, SS = 29,036, 6.7%, 95% CI 4.9%-9.0%), New Zealand (SS = 252,162, 7.7%, 95% CI 7.1%-8.3%), Australia (SS = 20,225, 6.1%, 95% CI 4.2%-8.7%), and Papua New Guinea (SS = 2,647, 7.0%, 95% CI 5.6%-8.8%). Pacific Islanders resident in the US were more likely to experience preterm birth compared to White women (OR = 1.45, 95% HPDI 1.32-1.58), but in New Zealand their risk was similar (OR = 1.00, 95% HPDI 0.83-1.16) to European women. Existing literature indicates that Pacific Islanders in the US had a higher prevalence of preterm birth and experienced health inequities. Learning from New Zealand's culturally-sensitive approach to health care provision may provide a starting point for addressing disparities. The limited number of studies identified may contribute to higher risk of bias and the heterogeneity in our estimates; more data is needed to understand the true burden of preterm birth in the Pacific region.

Preterm birth among Pacific Islanders in the United States and the US-affiliated Pacific Islands: A systematic review and meta-analysis

OBJECTIVE

To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US-Affiliated Pacific Islands.

METHODS

Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US-Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders.

RESULTS

Fourteen of the 3183 screened articles were included in meta-analyses. Random-effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%-13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%-23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR = 1.40, 95% CI: 1.28-1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre-pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth.

CONCLUSIONS

Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup-specific outcomes to address perinatal health disparities.

A scoping review key elements and effects of cardiovascular disease management programs based on community-based participatory research

BACKGROUND

This scoping review analyses the literature on community-based participatory research (CBPR)-based cardiovascular disease (CVD) management programmes, examining the key elements of their development and implementation and exploring their effectiveness.

METHODS

This scoping review's methodology had six stages: 1) identifying the research question; 2) identifying relevant studies-search strategy; 3) study selection; 4) charting the data; 5) collating, summarising, and reporting the results; and 6) consultation exercise. The databases used were PubMed, Cochrane, and CINAHL, for the period from 4 March to 3 April 2022. We selected studies 1) published after 2000; 2) targeting community residents over 18 years old; and 3) proposed a CBPR-based CVD management programme, described its development, and evaluated its effects based on its application. Data were extracted independently by each of the two researchers, using a standardised form.

RESULTS

Among the key aspects of such programmes were the many cases where community organisations led establishment of partnerships and cases where a decision-making committee was formed. Regarding application of the CBPR principles, community partners participated only in executing the research, not in analysing and interpreting research results. In addition, among the 21 studies selected were 6 randomised controlled trials, all of which showed a significant positive effect in experimental groups compared to control groups.

CONCLUSION

Improvement strategies are needed to allow implementation of CBPR principles in a CBPR-based CVD management programme. Moreover, further verification of programme evaluation research methods is needed.

SCOPING REVIEW REGISTRATION

This protocol has been registered to the OSF registries. 0000000204460911. Key Elements and Effects of Cardiovascular Disease Management Programs Based on Community-based Participatory Research: Protocol for a Scoping Review'. OSF, 4 Sept. 2020. Web.

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations

Background

Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches).

Methods

Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy.

Conclusion

The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.

Pacific Islands Cohort on Cardiometabolic Health Study: rationale and design

BACKGROUND

Pacific Islanders, including those residing in the US Affiliated Pacific Islands (USAPI), experience some of the highest mortality rates resulting from non-communicable diseases (NCDs) worldwide. The Pacific Island Health Officers' Association declared a Regional State of Health Emergency in 2010 due to the epidemic of NCDs in the USAPI. Obesity, a known risk factor for NCDs, has become an epidemic among both children and adults in Micronesia and other parts of the USAPI. There is some recent information about overweight and obesity (OWOB) among young children in the USAPI, but there is no data looking at the relationship between children and their biological parents. The Pacific Islands Cohort on Cardiometabolic Health (PICCAH) Study aims to collect data on NCD lifestyle factors from two generations of families (n = 600 child-parent dyads or 1,200 participants) living in Guam, Pohnpei, and Palau.

METHODS

The PICCAH Study is an epidemiological study using community-based convenience sampling to recruit participants in USAPI of Guam, Palau, and Pohnpei. The goal is to recruit participant dyads consisting of 1 child plus their biological parent in Guam (500 dyads or 1,000 participants), Pohnpei (50 dyads or 100 participants), and Palau (50 dyads or 100 participants). All participants are having the following information collected: demographic, health, and lifestyle information; anthropometry; diet; physical activity; sleep; acanthosis nigricans; blood pressure; and serum levels of fasting plasma glucose, fasting insulin, glycated hemoglobin, total cholesterol, triglycerides, LDL, and HDL.

DISCUSSION

The PICCAH Study is designed to establish the baseline of a generational epidemiologic cohort with an emphasis on cardiometabolic risk, and to better understand the extent of DM and CVD conditions and related risk factors of those living in the USAPI jurisdictions of Guam, Pohnpei, and Palau. This study also serves to further build research capacity in the underserved USAPI Region.

Pregnancy health and perinatal outcomes among Pacific Islander women in the United States and US Affiliated Pacific Islands: Protocol for a scoping review

This scoping review examines the literature on pregnancy and perinatal outcomes among Pacific Islander women in the United States (U.S.) and U.S.-affiliated Pacific Islands. Our aim was to identify research that disaggregated Pacific Islanders from other population groups. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) databases and a hand-search of grey literature. Forty-eight articles published between January 2010 and June 2020 were included. The majority of studies were conducted in Hawaii and utilized clinical record data. Infant outcomes were more commonly reported than maternal outcomes. We highlighted several limitations of the existing literature that included aggregation of Pacific Islanders with Asian American and other ethnic groups; limited comparison between Pacific Islander sub-groups; inadequate definitions of the nationality and ethnic composition of Pacific Islander groups; a lack of hypothesis-driven primary data collection and clinical trials; and underrepresentation of Pacific Islanders in population-based studies. Researchers should address these limitations to improve pregnancy and perinatal outcomes among Pacific Islanders, who comprise the second fastest growing ethnic minority in the U.S.

Gestational weight gain influences, beliefs, and goals among Marshallese pregnant women in Arkansas: a mixed-methods analysis

Despite the high rate of maternal and child health disparities among the Marshallese, there are no studies documenting gestational weight gain influences, beliefs, and goals among the Marshallese. From March 2019 to March 2020, a purposive sample of 33 participants took part in the mixed methods study. Two themes emerged: (1) Gestational Weight Gain Influences and (2) Excessive Gestational Weight Gain Perceptions. In the first theme there were three subthemes: (a) Church and Familial Influence on Gestational Weight Gain; (b) Healthy Gestational Weight Gain; and (c) Lack of Healthcare Provider Influence on Gestational Weight Gain. In the second theme there were three subthemes: (a) Excessive Weight Gain and Pregnancy; (b) Excessive Gestational Weight Gain and Labor; and (c) Gestational Weight Gain Goals. This study will be used to culturally tailor interventions to help Marshallese women reduce maternal and infant health disparities in Marshallese communities.

Preterm birth among Pacific Islander women and related perinatal outcomes: a scoping review protocol

INTRODUCTION

Infants born alive <37 weeks are classified as premature. The global estimate of preterm birth in 2014 was 10.6%, and it is the leading cause of death of children under the age of 5 years. Preterm birth disproportionately affects women of minority populations, yet knowledge about the incidence and associated outcomes among Pacific Islanders is limited. The objectives of this scoping review are to identify studies that describe risk factors, maternal-child health outcomes and existing interventions to prevent preterm birth among Pacific Islanders, and to summarise the barriers and facilitators to decrease the burden.

METHODS AND ANALYSIS

We will follow the Joanna Briggs Institute Manual for Evidence Synthesis for scoping reviews and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) to conduct this scoping review. The Covidence web application will be used for data management and consensus review. We will search on MEDLINE ALL (Ovid), EMBASE (Ovid), Web of Science Core Collection (as licensed at Yale), the Cochrane Library, CINAHL (EBSCOhost) and two non-indexed regional journals (Pacific Journal of Reproductive Health and Pacific Health Dialog). Title-abstract and full-text screening of eligible studies will be performed by two authors, and data will be extracted by the first author. Outcomes extracted will be presented using evidence mapping.

ETHICS AND DISSEMINATION

Findings will drive suggestions for new data collection needed to fill knowledge gaps and improve future study designs to decrease the burden of preterm birth among Pacific Islanders. There are no ethical concerns. This protocol will be disseminated in related peer-reviewed journals.

Key elements and effects of cardiovascular disease management programs based on community-based participatory research: protocol for a scoping review

BACKGROUND

Cardiovascular diseases (CVDs) are health problems that demonstrate high death and prevalence rates, and exhibit large health inequalities across different socio-economic status. Although interest in community-based participatory research (CBPR) is increasing because of the efforts to improve health equity, not enough literature review has been conducted on CBPR-based CVD management programs. The objective of this scoping review is to identify the key elements that should be considered when developing CBPR-based CVD management programs, and explore the effects of CBPR-based CVD management programs.

METHODS

This study will use the databases of PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) including grey literature. The criteria for selecting literature will be research that was published in or after 2000, applied CBPR, and either developed or implemented CVD management programs. No limit will be placed on the research design or method. Data extraction will be conducted independently by two researchers, and in the case of data mismatch, a consensus will be reached through discussion. The extracted data will be combined through narrative synthesis.

DISCUSSION

This scoping review will identify specific methods in the development and implementation process of CBPR-based CVD management programs, as well as the characteristics of the programs that were shown to be effective. Therefore, it will be able to provide specific guidelines to researchers, government agencies, and local organizations to design and implement participatory health promotion programs related to CVDs.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/ZW2UY.

Development of a Culturally Specific Leadership Curriculum through Community-Based Participatory Research and Popular Education

Background: The purpose of this innovative capacity building pilot project was to develop, implement, and evaluate a nine-workshop curriculum, Rekki Lemnak [Thinking of] Parent Leadership, to prepare community and academic partners for community organizing within the Micronesian Islander community. The purpose of the partnership was to build team leadership and research capacity to lay a foundation for implementing a change in healthcare and school systems. Working collaboratively helped ensure access to shared leadership through the learning by doing approach, enabling a culturally responsive method to build a sustainable partnership.

Approach: Community-based participatory research and Popular Education tenets and reflection were used as a guide in the development of the Rekki Lemnak [Thinking of] Parent Leadership curriculum. Nine workshops (two hours for eight workshops and three hours for one workshop) were held over a period of a year. Community and academic partners developed the learning objectives, capacity building topics, experiential activities, and an evaluation on the strengths and areas for improvement. The partnership consisted of seven Micronesian Islander parent leaders who are residents from the community at large, the Micronesian Islander Community organization including the Executive Director who is a community primary researcher and certified community health worker, and a Micronesian Islander-certified community health worker staff member, and the academic primary nurse researcher and another academic nurse researcher from Washington State University. A range from five to 10 partners with an average of eight attended the workshops, of which an average of five Micronesian Islander parent leaders attended the workshops. Community partners from the Micronesian Islander Community organization and the academic primary nurse researcher co-led four workshops. Community partners from the Micronesian Islander Community organization and MI parent leaders led two workshops respectively; academic nurse researcher partners led one workshop.

Outcomes: We identified three main themes: initially shy and humble MI parent leaders who through their participation transformed to empowered voices, togetherness—coming from different Islands and academia, and the need for more outreach to Micronesian Islanders.

Conclusions: Key elements of the Rekki Lemnak [Thinking of] Parent Leadership curriculum may be translatable to other community and academic partnerships. Culturally responsive research is more than a process in conducting a study. This requires an ongoing investment to establish and sustain authentic partnerships to conduct research with MI communities.

Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review

This scoping review identifies the best practices of community-based participatory research with Pacific Islanders in the United States and United States Affiliated Pacific Islands. Eighty-four articles from January 2000 to December 2017 were included in the review. Best practices included the importance of engaging Pacific Islander community leaders as research staff, community co-investigators, and community advisory board members. Best practices also focused on removing barriers to research by using participants' native languages, conducting research within the geographic community, and spending significant time to build trust. Novel best practices included honoring Pacific Islanders' cultural practices such as protocols for engagement, reciprocity, and social and spiritual inclusiveness and honoring Pacific Islanders' collectivist cultural structure. The goal of this scoping review is to aid community-academic partnerships working to improve the health of Pacific Islanders.

Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non-Hispanic whites

BACKGROUND

Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors.

METHODS

One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65 years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights.

RESULTS

Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P = .001), psychological MFH (36% vs 22%; P = .040), and behavioral MFH (27% vs 9%; P = .004) than NHWs. Among survivors aged <65 years, NHPIs reported less MFH (46% vs. 65%; P = .034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH.

CONCLUSIONS

A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation.