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Riccardi M, Pettinicchio V, Di Pumpo M, Altamura G, Nurchis MC, Markovic R, Šagrić Č, Stojanović M, Rosi L, Damiani G. Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review. Health Policy 2023; 137:104905. [PMID: 37716190 DOI: 10.1016/j.healthpol.2023.104905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/12/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.
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Affiliation(s)
- MariaTeresa Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Marcello Di Pumpo
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Roberta Markovic
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | | | - Miodrag Stojanović
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | - Luca Rosi
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità, ISS), Rome, Italy
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Taafaki MR, Taira D, Braun KL. Scoping Review of Interventional Studies in Chronic Disease for Native Hawaiian, Pacific Islander, and Filipino Populations in the United States. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:58-66. [PMID: 37901666 PMCID: PMC10612424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Native Hawaiians (NHs), Pacific Islanders (PIs), and Filipinos experience health disparities in the United States (US) and need interventions that work for them. The purpose of this paper is to present a review of interventions designed to address chronic disease in Native Hawaiian, Pacific Islander, and Filipino populations in the US that were tested for clinical impact through a randomized controlled trial (RCT). Articles were identified through a search of 4 databases, citation chasing, and colleagues. The 23 included articles reported on 21 interventions addressing 4 chronic conditions-cancer, obesity, cardiovascular disease, and diabetes. All projects were guided by advisory groups, and all interventions were theory-based and tailored to the population, with culturally- and language-appropriate educational materials delivered by same-race individuals in familiar church, club, or home settings. About half were tested through cluster RCT. The majority of the interventions were successful, confirming the value of developing and delivering interventions in partnership with community. Given the growing numbers of NHs, PIs, and Filipinos in the US, more investigational studies are needed to develop and test culturally tailored and grounded interventions that meet the health needs of these populations.
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Affiliation(s)
- Munirih R. Taafaki
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (MRT)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai’i at Hilo, Hilo, HI (DT)
| | - Kathryn L. Braun
- Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI (KLB)
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Lam EL, Kandula NR, Shah NS. The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders. J Racial Ethn Health Disparities 2023; 10:2588-2599. [PMID: 36329308 PMCID: PMC10154436 DOI: 10.1007/s40615-022-01438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Asian American, Native Hawaiians, and Other Pacific Islander (AANHPI) populations experience significant disparities in cardiovascular health. AANHPI populations also have strong, family-centered social relationships and networks. Since social networks may influence health behaviors, this review aimed to summarize research on the relationship between family social networks and cardiovascular health behaviors among AANHPI individuals. Current evidence suggests that family social network structures may play a particularly important role in smoking, dietary pattern, and physical activity behaviors among AANHPI individuals. Family networks may hinder or promote healthy behaviors through several social network mechanisms including social support, social influence, and social control. These effects vary across different AANHPI subgroups. Recommendations for future research on the role of social networks in health behaviors among AANHPI individuals are provided. Drawing on methodological advances and interventions that leverage social networks in AANHPI populations may be an avenue to improve health and reduce disparities.
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Affiliation(s)
- Emily L Lam
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Namratha R Kandula
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nilay S Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Mack M, Savila F, Bagg W, Harwood M, Swinburn B, Goodyear-Smith F. Interventions to prevent or manage obesity in Māori and Pacific adults: a systematic review and narrative synthesis. ETHNICITY & HEALTH 2023; 28:562-585. [PMID: 35608909 DOI: 10.1080/13557858.2022.2078482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake. DESIGN Systematic review of databases (Medline, PubMed, EMBASE, CINAHL, Scopus, CENTRAL), key non-indexed journals, and reference lists of included articles were searched from inception to June 2021. Eligibility criteria defined using a Population, Intervention, Control, Outcome format and study/publication characteristics. Quantitative and qualitative data were extracted and analysed using narrative syntheses. Study quality was assessed using modified GRADE approach. RESULTS From the 8190 articles identified, 21 were included, with 18 eligible for quantitative and five for qualitative analysis. The studies were heterogenous, with most graded as low quality. Some studies reported small but statistically significant improvements in weight and body mass index. Key enablers identified were social connection, making achievable sustainable lifestyle changes, culturally-centred interventions and incentives including money and enjoyment. Barriers to intervention uptake included difficulty in maintaining adherence to a programme due to intrinsic programme factors such as lack of social support and malfunctioning or lost equipment. CONCLUSIONS Normal weight trajectory is progressive increase over time. Modest weight loss or no weight gain after several years may have a positive outcome in lowering progression to diabetes, or improvement of glycaemic control in people with diabetes. We recommend urgent implementation of Māori and Pacific-led, culturally-tailored weight loss programmes that promote holistic, small and sustainable lifestyle changes delivered in socially appropriate contexts.
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Affiliation(s)
- Michaela Mack
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - F Savila
- Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - W Bagg
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - M Harwood
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - B Swinburn
- Department of Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
| | - F Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Aflague TF, Esquivel MK, Hammond K, Delos Reyes B, Kaholokula JK. Traditional and new lifestyle interventions to prevent breast cancer recurrence (TANICA): a qualitative study. Support Care Cancer 2023; 31:218. [PMID: 36929295 PMCID: PMC10020071 DOI: 10.1007/s00520-023-07663-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Breast cancer is the second cause of death from cancer in Guam and Hawai'i and disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Although a few culturally informed interventions addressing breast cancer survivorship exist, none have been developed or tested for Native Hawaiian, CHamoru, and Filipino women. To address this, the TANICA study began with key informant interviews in 2021. METHODS Purposive sampling and grounded theory approaches were used to conduct semi-structured interviews with individuals experienced in providing healthcare or implementing community programs and/or research with ethnic groups of interest in Guam and Hawai'i. A literature review and expert consultation identified intervention components, engagement strategies, and settings. Interview questions aimed to understand the relevance of evidence-based interventions and explored socio-cultural factors. Participants completed demographics and cultural affiliation surveys. Interviews were independently analyzed by trained researchers. Themes were mutually agreed upon by reviewers and key themes were identified based on frequencies. RESULTS Nineteen interviews were conducted in Hawai'i (n=9) and Guam (n=10). Interviews confirmed the relevance of most of the previously identified evidence-based intervention components for Native Hawaiian, CHamoru, and Filipino breast cancer survivors. Ideas around culturally responsive intervention components and strategies emerged that were shared across and unique to each ethnic group and site. CONCLUSION Evidence-based intervention components appear relevant, yet cultural and place-based strategies are needed for Native Hawaiian, CHamoru, and Filipino women in Guam and Hawai'i. Future research should triangulate these findings with the lived experiences of Native Hawaiian, CHamoru, and Filipino breast cancer survivors to develop culturally informed interventions.
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Affiliation(s)
- Tanisha F. Aflague
- grid.266410.70000 0004 0431 0698University of Guam, College of Natural and Applied Sciences, Mangilao, Guam, USA
| | - Monica K. Esquivel
- grid.410445.00000 0001 2188 0957University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, Hawai‘i USA
| | - Kristi Hammond
- grid.266410.70000 0004 0431 0698University of Guam, College of Natural and Applied Sciences, Mangilao, Guam, USA
| | - Bernice Delos Reyes
- grid.410445.00000 0001 2188 0957University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, Hawai‘i USA
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McElfish PA, Felix HC, Bursac Z, Rowland B, Yeary KHK, Long CR, Selig JP, Kaholokula JK, Riklon S. A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231152051. [PMID: 36799349 PMCID: PMC9940234 DOI: 10.1177/00469580231152051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.
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Affiliation(s)
- Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zoran Bursac
- Florida International University, Miami, FL, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | | | - James P. Selig
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Playdon M, Rogers TN, Brooks E, Petersen EM, Tavake-Pasi F, Lopez JA, Quintana X, Aitaoto N, Rogers CR. Sociocultural influences on dietary behavior and meal timing among Native Hawaiian and Pacific Islander women at risk of endometrial cancer: a qualitative investigation. Cancer Causes Control 2023; 34:23-37. [PMID: 36208351 PMCID: PMC9547093 DOI: 10.1007/s10552-022-01628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/06/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Determine sociocultural influences on dietary behavior, body image, weight loss, and perceptions of the cultural appropriateness of a meal-timing intervention design and menu among Native Hawaiian and Pacific Islander (NHPI) women at risk of endometrial cancer. METHODS Six 90-min videoconference focus groups among NHPI women (n = 35) recruited by a community champion in Utah. Eligible women were aged ≥ 18 years at risk of endometrial cancer (i.e., BMI ≥ 25 kg/m2, history of non-insulin-dependent diabetes or complex atypical endometrial hyperplasia) had a working cell phone capable of downloading a phone app, could use their cell phone during the day, and were not night-shift workers. Twelve semi-structured questions were posed during the focus groups. Using inductive qualitative methods based on Hatch's 9-step approach, de-identified transcript data were analyzed. RESULTS Overarching themes included economic factors, cultural influences, meal choice and timing, and perceptions of health. Subthemes included affordability, waste avoidance, inundated schedules, and cultural influences. Perceptions of body size and weight loss were influenced by family, community, and social media, whose messages could be conflicting. Important intervention components included satisfying, convenient pre-made meals, while barriers included the need to cook for family members. CONCLUSIONS Dietary interventions targeting metabolic health among NHPI women should consider the multitude of sociocultural and economic factors that influence food choices and meal timing in this population, including affordability, hectic schedules, and immigrant adjustment. Promoting the link between physical and mental well-being as opposed to weight loss is a key approach to reaching this population.
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Affiliation(s)
- M. Playdon
- grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA ,grid.223827.e0000 0001 2193 0096Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, RN4511, Salt Lake City, UT 84112 USA
| | - T. N. Rogers
- grid.223827.e0000 0001 2193 0096University of Utah David Eccles School of Business, Sorenson Impact Center, 85 Fort Douglas Blvd, Building #602, Salt Lake City, UT 84113 USA
| | - E. Brooks
- grid.223827.e0000 0001 2193 0096Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108 USA
| | - E. M. Petersen
- grid.223827.e0000 0001 2193 0096Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108 USA
| | - F. Tavake-Pasi
- National Tongan American Society, 5296 S Commerce Dr., Suite 204, Murray, UT 84117 USA
| | - J. A. Lopez
- grid.223827.e0000 0001 2193 0096Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108 USA
| | - X. Quintana
- grid.223827.e0000 0001 2193 0096Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, RN4511, Salt Lake City, UT 84112 USA
| | - N. Aitaoto
- grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 USA
| | - C. R. Rogers
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Institute for Health & Equity, 8701 W Watertown Plank Rd., Milwaukee, WI 53226 USA
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Hawley NL, Rivara AC, Naseri J, Faumuina K, Potoa’e-Solaita N, Iopu F, Faiai M, Naveno E, Tasele S, Lefale T, Lantini R, Carlson JC, Rabin TL, Semaia P, Mugadza P, Rosen RK. Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults. PLoS One 2023; 18:e0279084. [PMID: 36795707 PMCID: PMC9934313 DOI: 10.1371/journal.pone.0279084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. METHODS We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. DISCUSSION This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
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Affiliation(s)
- Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Joshua Naseri
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Kitiona Faumuina
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | | | - Francine Iopu
- Department of Public Health, Portland State University, Portland, OR, United States of America
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Susie Tasele
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Temukisa Lefale
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Ryan Lantini
- Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Penny Semaia
- Athletic Department, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Phyllis Mugadza
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rochelle K. Rosen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Palu E, MacMillan DF, McBride DKA, Thomson DR, Zarora R, Simmons D. Effects of lifestyle interventions on weight amongst Pasifika communities: A systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 25:100483. [PMID: 35669931 PMCID: PMC9162936 DOI: 10.1016/j.lanwpc.2022.100483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pasifika populations experience high incidence and prevalence of obesity and T2DM. However, no international review of lifestyle intervention studies amongst Pasifika communities exists. This study seeks to identify the effect and translatability of lifestyle strategies on weight amongst Pasifika populations. METHODS Lifestyle studies involving ≥90% adult Pasifika participants measuring weight change were eligible for inclusion. Database searching was carried out up to December 2021. Databases searched were MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCOhost) and ProQuest Central. Risk of bias was assessed using RoB2 (RCTs) and the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool. Meta-analysis and meta-regression used a bivariate random-effects model. Strategies were coded against pre-identified components of the newly proposed Cultural and Sustainability Assessment of Intervention (CSAI) framework. FINDINGS Twenty-three studies (n = 4258 participants) met inclusion and exclusion criteria. Thirty-two lifestyle strategies targeting weight loss (WL) and 7 targeting weight maintenance (WM) were extracted. Meta-analysis estimates small but significant effect of -0.26 standard deviations (95% CI -0.51 to -0.02), with RCTs demonstrating a non-significant effect of -0.23 standard deviations (95% CI -0.49 to 0.035). Culturally relevant strategies included community and peer support facilitators and team-based activities. The CSAI identified 14 out of 23 studies with low cultural competency and sustainability scores (<60%). INTERPRETATION Qualitative and quantitative analysis show tailored lifestyle interventions has had an estimated small but beneficial effect on WL amongst Pasifika communities. Potential for tailored interventions design to incorporate psychosocial and behavioural considerations. The CSAI has the potential for systematically identifying cultural and sustainability components of efficacy in interventions. FUNDING This review was funded under Western Sydney University's Postgraduate Research Scholarship.
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Dye CK, Corley MJ, Ing C, Lum-Jones A, Li D, Mau MKLM, Maunakea AK. Shifts in the immunoepigenomic landscape of monocytes in response to a diabetes-specific social support intervention: a pilot study among Native Hawaiian adults with diabetes. Clin Epigenetics 2022; 14:91. [PMID: 35851422 PMCID: PMC9295496 DOI: 10.1186/s13148-022-01307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Native Hawaiians are disproportionately affected by type 2 diabetes mellitus (DM), a chronic metabolic, non-communicable disease characterized by hyperglycemia and systemic inflammation. Unrelenting systemic inflammation frequently leads to a cascade of multiple comorbidities associated with DM, including cardiovascular disease, microvascular complications, and renal dysfunction. Yet few studies have examined the link between chronic inflammation at a cellular level and its relationship to standard DM therapies such as diabetes-specific lifestyle and social support education, well recognized as the cornerstone of clinical standards of diabetes care. This pilot study was initiated to explore the association of monocyte inflammation using epigenetic, immunologic, and clinical measures following a 3-month diabetes-specific social support program among high-risk Native Hawaiian adults with DM. RESULTS From a sample of 16 Native Hawaiian adults with DM, monocytes enriched from peripheral blood mononuclear cells (PBMCs) of 8 individuals were randomly selected for epigenomic analysis. Using the Illumina HumanMethylation450 BeadChip microarray, 1,061 differentially methylated loci (DML) were identified in monocytes of participants at baseline and 3 months following a DM-specific social support program (DM-SSP). Gene ontology analysis showed that these DML were enriched within genes involved in immune, metabolic, and cardiometabolic pathways, a subset of which were also significantly differentially expressed. Ex vivo analysis of immune function showed improvement post-DM-SSP compared with baseline, characterized by attenuated interleukin 1β and IL-6 secretion from monocytes. Altered cytokine secretion in response to the DM-SSP was significantly associated with changes in the methylation and gene expression states of immune-related genes in monocytes between intervention time points. CONCLUSIONS Our pilot study provides preliminary evidence of changes to inflammatory monocyte activity, potentially driven by epigenetic modifications, 3 months following a DM-specific SSP intervention. These novel alterations in the trajectory of monocyte inflammatory states were identified at loci that regulate transcription of immune and metabolic genes in high-risk Native Hawaiians with DM, suggesting a relationship between improvements in psychosocial behaviors and shifts in the immunoepigenetic patterns following a diabetes-specific SSP. Further research is warranted to investigate how social support influences systemic inflammation via immunoepigenetic modifications in chronic inflammatory diseases such as DM.
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Affiliation(s)
- Christian K Dye
- Department of Molecular Biosciences and Bioengineering, University of Hawaii, Honolulu, HI, 96822, USA
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222-K, Honolulu, HI, 96813, USA
| | - Michael J Corley
- Cornell Center for Immunology, Weill Cornell Medical Center, Cornell University, New York, NY, 10065, USA
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | - Claire Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | - Annette Lum-Jones
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, 96813, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, School of Medicine and Dentistry, University of Rochester, Rochester, NY, 14642, USA
| | - Marjorie K L M Mau
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA
| | - Alika K Maunakea
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St. BSB222-K, Honolulu, HI, 96813, USA.
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11
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Browne CV, Muneoka S, Ka'opua LS, Wu YY, Burrage RL, Lee YJ, Mokuau NK, Braun KL. Developing a culturally responsive dementia storybook with Native Hawaiian youth. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:315-327. [PMID: 33888037 DOI: 10.1080/02701960.2021.1885398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Similar to the nation's majority and racial/ethnic minority populations, Native Hawaiian families provide the bulk of care to loved ones with dementia. Limited research has focused on youth caregivers, who are largely invisible to the eldercare service system. This knowledge gap is especially critical for Native Hawaiians who place a high value on eldercare, often provided in multigenerational homes. To address this gap, we describe the process by which a university-community center developed a culturally responsive storybook on dementia targeted to Native Hawaiian youth. The development process honored community-based participatory research principles grounded in the cultural values and practices of Native Hawaiians, active collaboration of an advisory council, and face-to-face engagement with Native Hawaiian youth. Future directions are shared about culture-based programming and evaluation in dementia care that may be useful in work with other racial/ethnic youth and families.
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Affiliation(s)
- Colette V Browne
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Shelley Muneoka
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Lana Sue Ka'opua
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Yan Yan Wu
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Rachel L Burrage
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Yeonjung Jane Lee
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Noreen K Mokuau
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Kathryn L Braun
- Hā Kūpuna National Resource Center for Native Hawaiian Elders, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
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12
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Savila F, Bagg W, Swinburn B, van der Werf B, Letele D, Bamber A, Harding T, Goodyear-Smith F. Study protocol for evaluating Brown Buttabean Motivation (BBM): a community-based, Pacific-driven approach to health. BMC Public Health 2022; 22:630. [PMID: 35361189 PMCID: PMC8970058 DOI: 10.1186/s12889-022-12979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Buttabean Motivation (BBM) is a Pacific-led organisation which aims to reduce obesity amongst Pacific and Māori people in New Zealand enabling them to choose a healthy and active life-style for the duration of their lives, their children, their wider family and the community. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical role in nutrition and physical activity patterns. This study aims to evaluate the effectiveness of BBM for sustained health and wellbeing outcomes among its predominantly Pacific and Māori participants for both general BBM members and those with morbid obesity attending the 'From the Couch' programme. METHODS Quasi-experimental pre-post quantitative cohort study design with measured or self-reported weight at various time intervals for both cohorts. Weight will be analysed with general linear mixed model for repeated measures, and compared with a prediction model generated from the literature using a mixed method meta-analysis. The secondary outcome is change in pre- and post scores of Māori scale of health and well-being, Hua Oranga. DISCUSSION Multiple studies have shown that many diet and physical activity programmes can create short-term weight loss. The fundamental question is whether BBM members maintain weight loss over time. In New Zealand, Pacific and Māori engagement in health enhancing programmes remains an important strategy for achieving better health and wellbeing outcomes, and quality of life. Internationally, the collectivist cultures of indigenous and migrant and minority populations, living within dominant individualist western ideologies, have much greater burdens of obesity. If BBM members demonstrate sustained weight loss, this culturally informed community-based approach could benefit to other indigenous and migrant populations. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12621000931875 (BBM general members) First submitted 10 May 2021, registration completed 15 July 2021. ACTRN12621001676808 7 (From the Couch) First submitted 28 October 2021, registration completed 7 December 2021.
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Affiliation(s)
| | - Warwick Bagg
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- Population Nutrition and Global Health, University of Auckland, Auckland, New Zealand
| | - Bert van der Werf
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Dave Letele
- BBM, Unit 11 613-615 Great South Road, Manukau, Auckland, New Zealand
| | - Anele Bamber
- BBM, Unit 11 613-615 Great South Road, Manukau, Auckland, New Zealand
| | - Truely Harding
- Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, General Practice & Primary Health Care, University of Auckland, PB 92129, Auckland, 1142, New Zealand.
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13
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Railey AF, Muller C, Noonan C, Schmitter-Edgecombe M, Sinclair K, Kim C, Look M, Kaholokula JK. Cost Effectiveness of a Cultural Physical Activity Intervention to Reduce Blood Pressure Among Native Hawaiians with Hypertension. PHARMACOECONOMICS - OPEN 2022; 6:85-94. [PMID: 34389923 PMCID: PMC8807791 DOI: 10.1007/s41669-021-00291-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The aim of this study was to calculate the costs and assess whether a culturally grounded physical activity intervention offered through community-based organizations is cost effective in reducing blood pressure among Native Hawaiian adults with hypertension. METHODS Six community-based organizations in Hawai'i completed a randomized controlled trial between 2015 and 2019. Overall, 263 Native Hawaiian adults with uncontrolled hypertension (≥ 140 mmHg systolic, ≥ 90 mmHg diastolic) were randomized to either a 12-month intervention group of hula (traditional Hawaiian dance) lessons and self-regulation classes, or to an education-only waitlist control group. The primary outcome was change in systolic blood pressure collected at baseline and 3, 6, and 12 months for the intervention compared with the control group. Incremental cost-effectiveness ratios (ICERs) were calculated for primary and secondary outcomes. Non-parametric bootstrapping and sensitivity analyses evaluated uncertainty in parameters and outcomes. RESULTS The mean intervention cost was US$361/person, and the 6-month ICER was US$103/mmHg reduction in systolic blood pressure and US$95/mmHg in diastolic blood pressure. At 12 months, the intervention group maintained reductions in blood pressure, which exceeded reductions for usual care based on blood pressure outcomes. The change in blood pressure at 12 months resulted in ICERs of US$100/mmHg reduction in systolic blood pressure and US$93/mmHg in diastolic blood pressure. Sensitivity analyses suggested that at the estimated intervention cost, the probability that the program would lower systolic blood pressure by 5 mmHg was 67 and 2.5% at 6 and 12 months, respectively. CONCLUSION The 6-month Ola Hou program may be cost effective for low-resource community-based organizations. Maintenance of blood pressure reductions at 6 and 12 months in the intervention group contributed to potential cost effectiveness. Future studies should further evaluate the cost effectiveness of indigenous physical activity programs in similar settings and by modeling lifetime costs and quality-adjusted life-years. TRIAL REGISTRATION NUMBER NCT02620709.
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Affiliation(s)
- Ashley F Railey
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
- Department of Sociology, Indiana University, 1022 E. Third St, Bloomington, IN, 47405-7103, USA.
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | - Ka'imi Sinclair
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Corin Kim
- Kilohana, University of Hawai'i at Hilo, Hilo, HI, USA
| | - Mele Look
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
| | - J Keawe'aimoku Kaholokula
- Department of Native Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Mānoa, HI, USA
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14
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Kaholokula JK, Look M, Mabellos T, Ahn HJ, Choi SY, Sinclair KA, Wills TA, Seto TB, de Silva M. A Cultural Dance Program Improves Hypertension Control and Cardiovascular Disease Risk in Native Hawaiians: A Randomized Controlled Trial. Ann Behav Med 2021; 55:1006-1018. [PMID: 33677520 PMCID: PMC8489304 DOI: 10.1093/abm/kaaa127] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Native Hawaiians have higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites, calling for culturally responsive interventions to close this gap. PURPOSE We tested the effects of a 6-month behavioral intervention, a cultural dance program based on hula (the customary dance of Hawai'i), for improving blood pressure (BP) and CVD risk among Native Hawaiians with uncontrolled HTN. METHODS In a randomized controlled trial, we tested the effects of the hula-based intervention among 263 Native Hawaiians with uncontrolled HTN (systolic ≥ 140 or ≥ 130 mmHg if diabetes) and no CVD at enrollment. All participants received a brief culturally tailored heart health education before random assignment to the hula-based intervention (n = 131) or the education-only waitlist control (n = 132). Intervention received hula lessons and group-based activities for 6 months. Control received only 1-week education through 6 months. RESULTS Intervention yielded greater reductions in systolic (-15.3 mmHg) and diastolic (-6.4 mmHg) BP than control (-11.8 and -2.6 mmHg, respectively) from baseline to 6 months (p < .05). At 6 months, 43% of intervention participants compared to 21% of controls achieved a HTN stage <130/80 mmHg (p < .001). The 10-year CVD risk reduction was two times greater for the intervention group than the control group based on the Framingham Risk Score calculator. All improvements for intervention participants were maintained at 12 months. CONCLUSIONS This trial represents one of the few rigorously conducted examinations of an Indigenous practice leveraged for health promotion, with implications for other ethnic populations.
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Affiliation(s)
| | - Mele Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- Hālau Mōhala 'Ilima, Ka'ōhao, HI
| | - Tricia Mabellos
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - So Yung Choi
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - Ka'imi A Sinclair
- Institute for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
| | - Thomas A Wills
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- Cancer Prevention in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, HI
| | - Todd B Seto
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- The Queen’s Medical Center, The Queen’s Health Systems, Honolulu, HI
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15
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Uchima OK, Harrison GM, Hwang PW, Ho-Lastimosa I, Chung-Do JJ. Psychometric Evidence of the Attitudes Toward Food Scale for Native Hawaiians. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:251-256. [PMID: 34661120 PMCID: PMC8504297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many efforts are being made to promote healthy eating habits and nutrition among Native Hawaiian communities by cultivating positive attitudes toward healthy foods. However, there are limited quantitative scales that have been psychometrically validated with Native Hawaiian communities. This paper examines evidence on the reliability and validity of the Attitudes Toward Food (ATF) scale used with 68 Native Hawaiian adults from Waimānalo who are participating in a backyard aquaponics intervention called Mini Ahupua'a for Lifestyle and Mea'ai through Aquaponics (MALAMA). Exploratory factor analysis (EFA) and internal consistency reliability analysis were conducted to examine the underlying constructs of the ATF scale. Cognitive interviews with 3 MALAMA participants were also conducted to analyze how participants understood, processed, and responded to the scale. Findings from the cognitive interviews provided response-process evidence of validity and acceptability. Findings from the EFA revealed 2 factors. Factor 1 contained items that discussed confidence in preparing and using healthy foods. Factor 2 contained items that involved the consumption of healthy foods. The reliability analysis suggested that the 2 factors of the ATF scale are internally consistent (Cronbach's alpha = 0.79 and 0.71, respectively). Taken together, the evidence provides provisional support for the validity and reliability of the instrument for measuring attitudes among Native Hawaiians from Waimānalo. The ATF scale may be useful for similar health and nutritional programs for Native Hawaiians in Hawai'i. Future studies with larger samples and diverse sources of validity evidence may provide additional support of the scale's validity.
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Affiliation(s)
- Olivia K. Uchima
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (OKU, PWH, IH, JJC)
| | - George M. Harrison
- College of Education, University of Hawai‘i at Mānoa, Honolulu, HI (GMH)
| | - Phoebe W. Hwang
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (OKU, PWH, IH, JJC)
| | - Ilima Ho-Lastimosa
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (OKU, PWH, IH, JJC)
| | - Jane J. Chung-Do
- Office of Public Health Studies, University of Hawai‘i at Mānoa, Honolulu, HI (OKU, PWH, IH, JJC)
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16
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Oosman S, Nisbet C, Smith L, Abonyi S. Health promotion interventions supporting Indigenous healthy ageing: a scoping review. Int J Circumpolar Health 2021; 80:1950391. [PMID: 34313553 PMCID: PMC8317950 DOI: 10.1080/22423982.2021.1950391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aging well is a priority in Canada and globally, particularly for older Indigenous adults experiencing an increased risk of chronic conditions. Little is known about health promotion interventions for older Indigenous adults and most literature is framed within Eurocentric paradigms that are not always relevant to Indigenous populations. This scoping review, guided by Arksey and O'Malley's framework and the PRISMA-ScR Checklist, explores the literature on Indigenous health promoting interventions across the lifespan, with specific attention to Indigenous worldview and the role of older Indigenous adults within these interventions. To ensure respectful and meaningful engagement of Indigenous peoples, articles were included in the Collaborate or Shared Leadership categories on the Continuum of Engagement. Fifteen articles used Indigenous theories and frameworks in the study design. Several articles highlighted engaging Elders as advisors in the design and/or delivery of programs however only five indicated Elders were active participants. In this scoping review, we suggest integrating a high level of community engagement and augmenting intergenerational approaches are essential to promoting health among Indigenous populations and communities. Indigenous older adults are keepers of essential knowledge and must be engaged (as advisors and participants) in intergenerational health promotion interventions to support the health of all generations.
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Affiliation(s)
- Sarah Oosman
- School of Rehabilitation, College of Medicine Researcher, Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, Canada
| | - Christine Nisbet
- School of Rehabilitation, College of Medicine Researcher, Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, Canada
| | - Liris Smith
- School of Rehabilitation, College of Medicine Researcher, Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, Canada
| | - Sylvia Abonyi
- School of Rehabilitation, College of Medicine Researcher, Saskatchewan Population Health and Evaluation Research Unit (SPHERU), University of Saskatchewan, Saskatoon, Canada
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Matenga-Ikihele A, McCool J, Dobson R, Fa'alau F, Whittaker R. The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis. BMC Public Health 2021; 21:435. [PMID: 33663438 PMCID: PMC7931368 DOI: 10.1186/s12889-021-10420-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people. Methods Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020. Results Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities. Conclusions This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10420-9.
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Affiliation(s)
- Amio Matenga-Ikihele
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Moana Research, Nga Hau Māngere Birthing Centre, 14 Waddon Place, Auckland, Māngere, New Zealand.
| | - Judith McCool
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Fuafiva Fa'alau
- Pacific Health Section, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Firestone R, Faeamani G, Okiakama E, Funaki T, Henry A, Prapavessis D, Masaga J, Firestone J, Tiatia-Seath J, Matheson A, Brown B, Schleser M, Kaholokula K, Ing C, Borman B, Ellison-Loschmann L. Pasifika Prediabetes Youth Empowerment Programme: learnings from a youth-led community-based intervention study. THE NEW ZEALAND MEDICAL JOURNAL 2021; 134:57-68. [PMID: 33651778 PMCID: PMC8816523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Using a co-design approach, we describe exploratory findings of a community-based intervention to mobilise Pasifika communities into action, with the intent of reducing the risk factors of prediabetes. METHOD A group of 25 Pasifika youth aged 15-24 years from two distinctive Pasifika communities in New Zealand were trained to lead a small-scale, community-based intervention programme (among 29 participants) over the course of eight weeks. The intervention, which targeted adults aged 25-44 years who were overweight or obese, employed both an empowerment-based programme and a co-design approach to motivate community members to participate in a physical-activity-based intervention programme. RESULTS Findings show significant reductions in total body weight and waist circumference, as well as improved physical activity. CONCLUSIONS The strength of this intervention was evident in the innovative approach of utilising Pasifika-youth-led and co-designed approaches to motivate communities into healthier lifestyles. The approaches used in this project could be utilised in a primary healthcare setting as a community-wide strategy to reduce diabetes risk, particularly among Pasifika peoples.
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Affiliation(s)
- Ridvan Firestone
- Senior Research Officer/Principal Investigator, Centre for Public Health Research, Massey University
| | - Gavin Faeamani
- The Fono, 411 Great North Road, Henderson, Auckland 0612, New Zealand
| | - Elizabeth Okiakama
- South Waikato Pacific Islands Community Services, 1 Maraetai Road, Tokoroa 3444, New Zealand
| | - Tevita Funaki
- The Fono, 411 Great North Road, Henderson, Auckland 0612, New Zealand
| | - Akarere Henry
- South Waikato Pacific Islands Community Services, 1 Maraetai Road, Tokoroa 3444, New Zealand
| | - Danielle Prapavessis
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jennifer Masaga
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Justice Firestone
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jemaima Tiatia-Seath
- School of Māori Studies and Pacific Studies, Faculty of Arts, University of Auckland, Bldg 273, 20 Wynyard Street, Auckland 1010, New Zealand
| | - Anna Matheson
- School of Health, Faculty of Health, Victoria University of Wellington, Level 1, Student Union Building, Wellington, New Zealand
| | - Blakely Brown
- School of Public and Community Health Sciences, College of Health Professions & Biomedical Sciences, University of Montana, 340 Skaggs Building, Missoula, MT 59812, USA
| | - Max Schleser
- Department of Film and Animation, School of Arts, Social Sciences and Humanities, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne 3122, Australia
| | - Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd. 1016, Honolulu, Hawaii 96813
| | - Claire Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd. 1016, Honolulu, Hawaii 96813
| | - Barry Borman
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Lis Ellison-Loschmann
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
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Browne CV, Braun KL, Mokuau NK, Wu YY, Muneoka S. Examining Long-Term Service and Support Needs and Preferences of Native Hawaiian Elders: A Mixed-Method Approach. J Aging Health 2020; 32:582-590. [PMID: 30957684 PMCID: PMC6996835 DOI: 10.1177/0898264319839903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The Native Hawaiian population experiences numerous disparities in health and income. Using a mixed-method research (MMR) design, we summarize findings from three phases of an MMR approach used to uncover kūpuna (elder) long-term service and support (LTSS) needs and care preferences. Methods: Key informants in Hawaiian health were interviewed, secondary analyses of large state data sets were conducted, and kūpuna and "ohana (family) caregivers were engaged in listening sessions. Results: Quantitative data confirmed numerous health disparities experienced by older Native Hawaiians, whereas qualitative data exposed their limited knowledge of this poor health profile and revealed their historical and contemporary experiences with discrimination in education, employment, and health care. Hawaiian culture was identified as a continued source of resilience in support of elders and family caregiving regardless of geographic setting. Discussion: We suggest three practice, policy, and research directions that offer the potential to respond to and improve kūpuna health and service use.
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Affiliation(s)
| | | | | | - Yan Yan Wu
- University of Hawai‘i at Mānoa, Honolulu, USA
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20
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McElfish PA, Yeary K, Sinclair IA, Steelman S, Esquivel MK, Aitaoto N, Kaholokula K, Purvis RS, Ayers BL. Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review. J Health Care Poor Underserved 2020; 30:1302-1330. [PMID: 31680100 DOI: 10.1353/hpu.2019.0101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
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.
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Oetzel J, Rarere M, Wihapi R, Manuel C, Tapsell J. A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity. Int J Equity Health 2020; 19:103. [PMID: 32571330 PMCID: PMC7310040 DOI: 10.1186/s12939-020-01222-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background Māori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework. Methods The partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data. Results The co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0). Conclusion The HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities. Trial registration Retrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.
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Affiliation(s)
- John Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand.
| | - Moana Rarere
- National Institute of Demographic and Economic Analysis (NIDEA), University of Waikato, Hamilton, New Zealand
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Harding T, Oetzel J. Implementation effectiveness of health interventions for indigenous communities: a systematic review. Implement Sci 2019; 14:76. [PMID: 31382994 PMCID: PMC6683565 DOI: 10.1186/s13012-019-0920-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION Not registered.
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Affiliation(s)
- Truely Harding
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - John Oetzel
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
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Schuette SAP, Cordero E, Slosburg K, Addington EL, Victorson D. A Scoping Review of Positive Lifestyle and Wellness Interventions to Inform the Development of a Comprehensive Health Promotion Program: "HealthPro". Am J Lifestyle Med 2019; 13:336-346. [PMID: 31285713 PMCID: PMC6600616 DOI: 10.1177/1559827617704825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Lifestyle medicine has emerged as a transformational force in mainstream health care. Numerous health promotion and wellness programs have been created to facilitate the adoption of increased positive, modifiable health behaviors to prevent and lessen the effects of chronic disease. This article provides a scoping review of available health promotion interventions that focus on healthy adult populations in the past 10 years. Methods. We conducted a scoping review of the literature searching for health promotion interventions in the past 10 years. Interventions were limited to those conducted among healthy adults that offered a face-to-face, group-based format, with positive results on one or more health outcomes. We then developed a new health promotion intervention that draws on multiple components of included interventions. Results. Fifty-eight articles met our inclusion criteria. Physical activity was the primary focus of a majority (N = 47) of articles, followed by diet/nutrition (N = 40) and coping/social support (N = 40). Conclusions. Efficacious health promotion interventions are critical to address the prevention of chronic disease by addressing modifiable risk factors such as exercise, nutrition, stress, and coping. A new intervention, discussed is this article, provides a comprehensive approaches to health behavior change and may be adapted for future research.
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Affiliation(s)
- Stephanie A. P. Schuette
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Evelyn Cordero
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Katherine Slosburg
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - Elizabeth L. Addington
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine, Chicago, Illinois (SAPS, EC, KS, ELA, DV)
- Osher Center for Integrative Medicine at Northwestern,
Northwestern Medicine, Chicago, Illinois (SAPS, ELA, DV)
| | - David Victorson
- David Victorson, PhD, 2205 Tech Drive, Suite 2-120,
Northwestern University, Chicago, IL 60208; e-mail:
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Ho-Lastimosa I, Chung-Do JJ, Hwang PW, Radovich T, Rogerson I, Ho K, Keaulana S, Keawe'aimoku Kaholokula J, Spencer MS. Integrating Native Hawaiian tradition with the modern technology of aquaponics. Glob Health Promot 2019; 26:87-92. [PMID: 30964410 DOI: 10.1177/1757975919831241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior to western arrival in 1778, Native Hawaiians possessed a sophisticated culture and resource management system conducive to an island ecosystem. However, disenfranchisement from ancestral lands and traditional food sources as a result of colonization led to Native Hawaiians being forced to abandon many of their traditional practices. Today, many Native Hawaiians experience food insecurity, placing them at further risk for obesity and other nutrition-related chronic diseases. Consequently, there is a growing need for place-based and culturally relevant strategies rooted in Hawaiian epistemology to address these issues. This paper describes the history and development of one such intervention - the MALAMA study - in the community of Waimānalo that innovatively merges the modern technology of aquaponics with traditional Native Hawaiian practices and values.
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Affiliation(s)
- Ilima Ho-Lastimosa
- 1 College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.,3 God's Country Waimānalo. Honolulu, Hawai'i, USA.,4 Ke Kula Nui O Waimānalo, Waimānalo, Hawai'i, USA
| | - Jane J Chung-Do
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.,3 God's Country Waimānalo. Honolulu, Hawai'i, USA.,4 Ke Kula Nui O Waimānalo, Waimānalo, Hawai'i, USA
| | - Phoebe W Hwang
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.,3 God's Country Waimānalo. Honolulu, Hawai'i, USA
| | - Theodore Radovich
- 1 College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.,3 God's Country Waimānalo. Honolulu, Hawai'i, USA.,4 Ke Kula Nui O Waimānalo, Waimānalo, Hawai'i, USA
| | - Ikaika Rogerson
- 3 God's Country Waimānalo. Honolulu, Hawai'i, USA.,4 Ke Kula Nui O Waimānalo, Waimānalo, Hawai'i, USA
| | - Kenneth Ho
- 3 God's Country Waimānalo. Honolulu, Hawai'i, USA.,4 Ke Kula Nui O Waimānalo, Waimānalo, Hawai'i, USA.,5 University of Southern California, Los Angeles, California, USA
| | - Samantha Keaulana
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA.,3 God's Country Waimānalo. Honolulu, Hawai'i, USA
| | | | - Michael S Spencer
- 7 School of Social Work and Indigenous Wellness Research Institute, University of Washington, Seattle, Washington, USA
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Collier AF, Daiss S, Temengil E, Russell SC, Miller JC, Renguul FM. Developing an obesity intervention in Micronesia: From needs assessment to planning. EVALUATION AND PROGRAM PLANNING 2018; 69:33-42. [PMID: 29665478 DOI: 10.1016/j.evalprogplan.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/04/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Evidence-based obesity reduction programs in the Pacific are scarce to nonexistent. Using a community-based participatory research model (CBPR) we developed a collaboration between our university and a small Pacific Island nation. We established an advisory council of local stakeholders and then conducted an extensive needs assessment with youth, parents, professionals, and lay public. Only 9% of participants had tried a weight loss program. There was a strong tendency to engage in binge-eating cycles; difficulty eating healthy during frequent community celebrations with few healthy food options available in general; and limited traditions that involved physical activity. Participants wanted to learn how to increase their physical activity, make healthier food choices, and learn to reward themselves for healthy behaviors. Diets were most frequently high in energy or protein foods, followed by starch, sugary and fried foods; they ate vegetables and fruits least often. Together, our team then created the culturally relevant Fit Kit Palau©. We highlight lessons learned including how to determine partnerships; manage multiple cultural and geographic barriers; build capacity; and balance program fidelity with responsivity. As the program moves forward, we hope to increase access, engagement, and adherence and provide a model for other PI countries.
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Affiliation(s)
- Ann Futterman Collier
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Suzanne Daiss
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Everlynn Temengil
- Behavioral Health, Ministry of Health, Koror, 96940, Republic of Palau.
| | - Samantha Cody Russell
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Julia Caroline Miller
- Department of Psychological Sciences, Northern Arizona University, PO Box 15106, Flagstaff, AZ, 86011, United States.
| | - Fumiana M Renguul
- Behavioral Health, Ministry of Health, Koror, 96940, Republic of Palau.
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Galaviz KI, Weber MB, Straus A, Haw JS, Narayan KMV, Ali MK. Global Diabetes Prevention Interventions: A Systematic Review and Network Meta-analysis of the Real-World Impact on Incidence, Weight, and Glucose. Diabetes Care 2018; 41:1526-1534. [PMID: 29934481 PMCID: PMC6463613 DOI: 10.2337/dc17-2222] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/30/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Understanding the real-world impacts of lifestyle modification (LSM) for diabetes prevention is imperative to inform resource allocation. The purpose of this study was to synthetize global evidence on the impact of LSM strategies on diabetes incidence and risk factors in one parsimonious model. RESEARCH DESIGN AND METHODS PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for studies published between January 1990 and April 2015. Effectiveness/translation studies of any design testing LSM strategies, targeting high-risk populations (with prediabetes or diabetes risk factors), and reporting diabetes incidence, weight, or glucose outcomes were included. We extracted number of diabetes cases/incidence rates and mean changes in weight (kg), fasting blood glucose (FBG, mmol/L), 2-h postload glucose (mmol/L), and hemoglobin A1c (%). Pairwise random-effects and frequentist random-effects network meta-analyses were used to obtain pooled effects. RESULTS Sixty-three studies were pooled in the meta-analysis (n = 17,272, mean age 49.7 years, 28.8% male, 60.8% white/European). In analyses restricted to controlled studies (n = 7), diabetes cumulative incidence was 9% among intervention participants and 12% among control participants (absolute risk reduction 3%; relative risk 0.71 [95% CI 0.58, 0.88]). In analyses combining controlled and uncontrolled studies (n = 14), participants receiving group education by health care professionals had 33% lower diabetes odds than control participants (odds ratio 0.67 [0.49, 0.92]). Intervention participants lost 1.5 kg more weight [-2.2, -0.8] and achieved a 0.09 mmol/L greater FBG decrease [-0.15, -0.03] than control participants. Every additional kilogram lost by participants was associated with 43% lower diabetes odds (β = 0.57 [0.41, 0.78]). CONCLUSIONS Real-world LSM strategies can reduce diabetes risk, even with small weight reductions.
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Affiliation(s)
- Karla Ivette Galaviz
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Jeehea Sonya Haw
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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Kaholokula JK, Ing CT, Look MA, Delafield R, Sinclair K. Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Ann Hum Biol 2018; 45:249-263. [PMID: 29843522 PMCID: PMC6002761 DOI: 10.1080/03014460.2018.1465593] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CONTEXT Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic realities are a public health priority. OBJECTIVE To describe cultural adaptation and culturally grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai'i: PILI 'Ohana and KāHOLO Projects. METHODS A literature review of 14 studies from these two projects was done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the 'ground up' to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioural outcomes of both types of interventions. RESULTS Both culturally adapted and culturally grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes and hypertension. CONCLUSION Several recommendations are provided based on the lessons learned from the PILI 'Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.
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Affiliation(s)
| | - Claire Townsend Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Mele A. Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Ka‘imi Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University
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Ing CT, Miyamoto RES, Fang R, Antonio M, Paloma D, Braun KL, Kaholokula JK. Comparing Weight Loss-Maintenance Outcomes of a Worksite-Based Lifestyle Program Delivered via DVD and Face-to-Face: A Randomized Trial. HEALTH EDUCATION & BEHAVIOR 2018; 45:569-580. [PMID: 29504468 DOI: 10.1177/1090198118757824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Native Hawaiians and other Pacific Islanders have high rates of overweight and obesity compared with other ethnic groups in Hawai'i. Effective weight loss and weight loss-maintenance programs are needed to address obesity and obesity-related health inequities for this group. AIMS Compare the effectiveness of a 9-month, worksite-based, weight loss-maintenance intervention delivered via DVD versus face-to-face in continued weight reduction and weight loss maintenance beyond the initial weight loss phase. METHOD We tested DVD versus face-to-face delivery of the PILI@Work Program's 9-month, weight loss-maintenance phase in Native Hawaiian-serving organizations. After completing the 3-month weight loss phase, participants ( n = 217) were randomized to receive the weight loss-maintenance phase delivered via trained peer facilitators or DVDs. Participant assessments at randomization and postintervention included weight, height, blood pressure, physical functioning, exercise frequency, and fat intake. RESULTS Eighty-three face-to-face participants were retained at 12 months (74.1%) compared with 73 DVD participants (69.5%). There was no significant difference between groups in weight loss or weight loss maintenance. The number of lessons attended in Phase 1 of the intervention (β = 0.358, p = .022) and baseline systolic blood pressure (β = -0.038, p = .048) predicted percent weight loss at 12 months. DISCUSSION AND CONCLUSION Weight loss maintenance was similar across groups. This suggests that low-cost delivery methods for worksite-based interventions targeting at-risk populations can help address obesity and obesity-related disparities. Additionally, attendance during the weight loss phase and lower baseline systolic blood pressure predicted greater percent weight loss during the weight loss-maintenance phase, suggesting that early engagement and initial physical functioning improve long-term weight loss outcomes.
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Affiliation(s)
| | | | - Rui Fang
- 1 University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | | | - Diane Paloma
- 2 Queen's Health Systems, Honolulu, Hawai'i, USA
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Fergusson D, Monfaredi Z, Pussegoda K, Garritty C, Lyddiatt A, Shea B, Duffett L, Ghannad M, Montroy J, Murad MH, Pratt M, Rader T, Shorr R, Yazdi F. The prevalence of patient engagement in published trials: a systematic review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:17. [PMID: 29796308 PMCID: PMC5963039 DOI: 10.1186/s40900-018-0099-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/17/2018] [Indexed: 05/20/2023]
Abstract
PLAIN ENGLISH SUMMARY With the growing movement to engage patients in research, questions are being asked about who is engaging patients and how they are being engaged. Internationally, research groups are supporting and funding patient-oriented research studies that engage patients in the identification of research priorities and the design, conduct and uptake of research. As we move forward, we need to know what meaningful patient engagement looks like, how it benefits research and clinical practice, and what are the barriers to patient engagement?We conducted a review of the published literature looking for trials that report engaging patients in the research. We included both randomized controlled trials and non-randomized comparative trials. We looked at these trials for important study characteristics, including how patients were engaged, to better understand the practices used in trials. Importantly, we also discuss the number of trials reporting patient engagement practices relative to all published trials. We found that very few trials report any patient engagement activities even though it is widely supported by many major funding organizations. The findings of our work will advance patient-oriented research by showing how patients can be engaged and by stressing that patient engagement practices need to be better reported. BACKGROUND Patient-Oriented Research (POR) is research informed by patients and is centred on what is of importance to them. A fundamental component of POR is that patients are included as an integral part of the research process from conception to dissemination and implementation, and by extension, across the research continuum from basic research to pragmatic trials [J Comp Eff Res 2012, 1:181-94, JAMA 2012, 307:1587-8]. Since POR's inception, questions have been raised as to how best to achieve this goal.We conducted a systematic review of randomized controlled trials and non-randomized comparative trials that report engaging patients in their research. Our main goal was to describe the characteristics of published trials engaging patients in research, and to identify the extent of patient engagement activities reported in these trials. METHODS The MEDLINE®, EMBASE®, Cinahl, PsycINFO, Cochrane Methodology Registry, and Pubmed were searched from May 2011 to June 16th, 2016. Title, abstract and full text screening of all reports were conducted independently by two reviewers. Data were extracted from included trials by one reviewer and verified by a second. All trials that report patient engagement for the purposes of research were included. RESULTS Of the 9490 citations retrieved, 2777 were reviewed at full text, of which 23 trials were included. Out of the 23 trials, 17 were randomized control trials, and six were non-randomized comparative trials. The majority of these trials (83%, 19/23) originated in the United States and United Kingdom. The trials engaged a range of 2-24 patients/ community representatives per study. Engagement of children and minorities occurred in 13% (3/23) and 26% (6/23) of trials; respectively. Engagement was identified in the development of the research question, the selection of study outcomes, and the dissemination and implementation of results. CONCLUSIONS The prevalence of patient engagement in patient-oriented interventional research is very poor with 23 trials reporting activities engaging patients. Research dedicated to determining the best practice for meaningful engagement is still needed, but adequate reporting measures also need to be defined.
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Affiliation(s)
- Dean Fergusson
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Centre for Practice-Changing Research, Office L1298a, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6 Canada
| | | | | | | | - Anne Lyddiatt
- Patient Partner SPOR National Steering Committee, Ottawa, ON Canada
| | - Beverley Shea
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Lisa Duffett
- Department of Hematology, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mona Ghannad
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - M. Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN USA
| | - Misty Pratt
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON Canada
| | | | - Fatemeh Yazdi
- Ottawa Hospital Research Institute, Ottawa, ON Canada
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Townsend CKM, Miyamoto RES, Antonio M, Zhang G, Paloma D, Basques D, Braun KL, Kaholokula JK. The PILI@Work Program: a translation of the diabetes prevention program to Native Hawaiian-serving worksites in Hawai'i. Transl Behav Med 2017; 6:190-201. [PMID: 27356989 PMCID: PMC4927448 DOI: 10.1007/s13142-015-0383-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A previously translated Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was adapted for delivery as a worksite-based intervention, called PILI@Work, to address obesity disparities in Native Hawaiians/Pacific Islanders. This study examined the effectiveness of PILI@Work and factors associated with weight loss at post-intervention. Overweight/obese employees of 15 Native Hawaiian-serving organizations received the 3-month component of PILI@Work. Assessments included weight, systolic/diastolic blood pressure, physical activity and functioning, fat intake, locus of weight control, social support, and self-efficacy. Weight, systolic/diastolic blood pressure, physical functioning, physical activity frequency, fat intake, family support, and eating self-efficacy improved from pre- to post-intervention. Regression analysis indicated that worksite type, decreased diastolic blood pressure, increased physical activity, and more internalized locus of weight control were significantly associated with 3-month weight loss. PILI@Work initiated weight loss in Native Hawaiians/Pacific Islanders. DPP-LI translated to worksite settings and tailored for specific populations can be effective for addressing obesity.
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Affiliation(s)
- Claire K M Townsend
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA.
| | - Robin E S Miyamoto
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Mapuana Antonio
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Guangxing Zhang
- Office of Biostatistics & Quantitative Health Sciences John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Diane Paloma
- Native Hawaiian Health Program, Queen's Health Systems, Honolulu, HI, USA
| | - DeAnna Basques
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
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Delafield R, Hermosura AN, Ing CT, Hughes CK, Palakiko DM, Dillard A, Kekauoha BP, Yoshimura SR, Gamiao S, Kaholokula JK. A Community-Based Participatory Research Guided Model for the Dissemination of Evidence-Based Interventions. Prog Community Health Partnersh 2017; 10:585-595. [PMID: 28569684 PMCID: PMC5458619 DOI: 10.1353/cpr.2016.0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dissemination is a principle within community-based participatory research (CBPR); however, published research focuses on the dissemination of findings from CBPR projects but less on dissemination of interventions developed through CBPR approaches. To disseminate an evidence-based lifestyle intervention tailored for Native Hawaiians and other Pacific Islanders, the PILI 'Ohana Project (POP), an 11-year CBPR initiative, developed an innovative dissemination model. OBJECTIVES The community-to-community mentoring (CCM) model described in this paper extends the application of CBPR values and principles used in intervention development to intervention dissemination. METHODS The CCM model combines a CBPR orientation with the diffusion of innovation theory, the social cognitive theory, and key concepts from community organizing and community building to address the multilevel factors that influence uptake of an evidence-based intervention (EBI). Grounding the model in CBPR principles provides benefits for intervention dissemination and integrates a focus on community benefits and capacity building. CONCLUSIONS By establishing co-equal, mutually beneficial relationships at the core of the CCM model, opportunities are created for building critical consciousness, community capacity, and social capital. More research is needed to determine the effectiveness of this model of intervention dissemination which may enhance diffusion of CBPR interventions and empower communities in the process.
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Kaholokula JK, Look MA, Wills TA, de Silva M, Mabellos T, Seto TB, Ahn HJ, Sinclair KA, Buchwald D. Kā-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians. BMC Public Health 2017; 17:321. [PMID: 28415975 PMCID: PMC5392978 DOI: 10.1186/s12889-017-4246-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background As a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Kā-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk. Methods A 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only. Discussion This trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities. Trial registration ClinicalTrials.gov: NCT02620709, registration date November 23, 2015.
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Affiliation(s)
| | - Mele A Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA.,Hālau Mōhala 'Ilima, Kailua, USA
| | | | | | - Tricia Mabellos
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Todd B Seto
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Hyeong Jun Ahn
- Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Ka'imi A Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, USA
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Nava LT, Zambrano JM, Arviso KP, Brochetti D, Becker KL. Nutrition-based interventions to address metabolic syndrome in the Navajo: a systematic review. J Clin Nurs 2015; 24:3024-45. [PMID: 26239838 DOI: 10.1111/jocn.12921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES The objective of this systematic review is to identify nutrition-based interventions that may be effective for the prevention and treatment of metabolic syndrome in the Navajo. BACKGROUND Metabolic syndrome, a major risk factor for cardiovascular disease, affects almost half of the Navajo population. The diet of the Navajo, heavy in fat and refined carbohydrates, has been identified as an important contributing factor to the high rates of metabolic syndrome in this population. DESIGN A search was conducted on PubMed, EMBASE and CINAHL to identify studies published before October, 2013, involving nutrition-based interventions in adult populations similar to the Navajo targeting at least one measure of metabolic syndrome. METHODS Data on efficacy and participation were gathered and synthesised qualitatively. RESULTS Out of 19 studies included in this systematic review, 11 interventions were identified to be effective at improving at least one measure of metabolic syndrome. Level of exposure to the intervention, frequency of intervention activities, family and social support, cultural adaptation and case management were identified as factors that may improve the efficacy of an intervention. CONCLUSIONS Multiple nutrition-based interventions have been found to be effective in populations similar to the Navajo. RELEVANCE TO CLINICAL PRACTICE Development of a strategy to address metabolic syndrome in the Navajo may involve aspects from multiple interventions to increase efficacy and maximise participation.
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Affiliation(s)
| | | | - Karen P Arviso
- Division of Public Health, Crownpoint Healthcare Facility, Crownpoint, NM, USA
| | - Denise Brochetti
- Diabetes Education, Crownpoint Healthcare Facility, Crownpoint, NM, USA
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Acceptability and non-compliance in a family-led weight-management programme for obese Pacific children. Public Health Nutr 2015; 18:2625-33. [DOI: 10.1017/s1368980014003255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo explore factors influencing participation and attrition in a family-led weight-management programme for obese Pacific children.DesignQualitative study used bilingual in-depth interviews at exit and end of an 8-week weight-management programme.SettingNew Zealand.SubjectsForty-two parents/primary caregivers of obese children who were randomised in the intervention weight-management programme.ResultsProgrammatic factors that enhanced retention included: simultaneous delivery to both children and parents as participants; delivery of the programme in small group settings at local community venues; enabling trustworthy and accountable relationships; providing resources for travel to venues and regular telephone/text messaging follow-up calls reinforcing programme goals; and day and time scheduling. Suggested programme improvements included having ethnic-specific Island-language delivery and practical sessions like cooking classes and shopping expeditions at local food stores. The research found that unpredictable external life crises like extended family deaths, a change in job shift, family illnesses (both acute and those requiring chronic management) and long-term family visitations affected participation and momentum. A loss of momentum through managing life crises was often difficult to overcome for participants, leading them to drop out of the weight-management programme. Most drop-out participants preferred to defer their programme participation with hopes of re-committing to future programmes at another time.ConclusionsIn order for weight-management programmes to be effective, participants must be able to complete them. Identifying factors that predict participation and attrition may serve as a basis for programme improvement.
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Kaholokula JK, Kekauoha P, Dillard A, Yoshimura S, Palakiko DM, Hughes C, Townsend CK. The PILI 'Ohana Project: a community-academic partnership to achieve metabolic health equity in Hawai'i. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2014; 73:29-33. [PMID: 25535599 PMCID: PMC4271354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Native Hawaiians and Pacific Islanders (NHPI) have higher rates of excess body weight and related medical disorders, such as diabetes and cardiovascular disease, compared to other ethnic groups in Hawai'i. To address this metabolic health inequity, the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project, a community-academic partnership, was formed over eight years ago and developed two community-placed health promotion programs: the PILI Lifestyle Program (PLP) to address overweight/obesity and the Partners in Care (PIC) to address diabetes self-care. This article describes and reviews the innovations, scientific discoveries, and community capacity built over the last eight years by the PILI 'Ohana Project's (POP) partnership in working toward metabolic health equity. It also briefly describes the plans to disseminate and implement the PLP and PIC in other NHPI communities. Highlighted in this article is how scientific discoveries can have a real-world impact on health disparate populations by integrating community wisdom and academic expertise to achieve social and health equity through research.
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Affiliation(s)
| | - Puni Kekauoha
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
| | - Adrienne Dillard
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
| | - Sheryl Yoshimura
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
| | - Donna-Marie Palakiko
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
| | - Claire Hughes
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
| | - Claire Km Townsend
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (JKK,CKMT)
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Kaholokula JK, Wilson RE, Townsend CKM, Zhang GX, Chen J, Yoshimura SR, Dillard A, Yokota JW, Palakiko DM, Gamiao S, Hughes CK, Kekauoha BK, Mau MK. Translating the Diabetes Prevention Program in Native Hawaiian and Pacific Islander communities: the PILI 'Ohana Project. Transl Behav Med 2014; 4:149-59. [PMID: 24904698 PMCID: PMC4041922 DOI: 10.1007/s13142-013-0244-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Native Hawaiians/Pacific Islanders experience a high prevalence of overweight/obesity. The Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was translated into a 3-month community-based intervention to benefit these populations. The weight loss and other clinical and behavioral outcomes of the translated DPP-LI and the socio-demographic, behavioral, and biological factors associated with the weight loss were examined. A total of 239 Native Hawaiian/Pacific Islander adults completed the translated DPP-LI through four community-based organizations (CBOs). Changes from pre- to post-intervention assessments in weight, blood pressure, physical functioning, exercise frequency, and fat in diet were measured. Significant improvements on all variables were found, with differences observed across the four CBOs. CBOs with predominately Native Hawaiian and ethnically homogenous intervention groups had greater weight loss. General linear modeling indicated that larger baseline weight and CBO predicted weight loss. The translated DPP-LI can be effective for Native Hawaiians/Pacific Islanders, especially when socio-cultural, socio-economic, and CBO-related contextual factors are taken into account.
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Affiliation(s)
- J K Kaholokula
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - R E Wilson
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - C K M Townsend
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - G X Zhang
- />Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - J Chen
- />Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - S R Yoshimura
- />Kōkua Kalihi Valley Comprehensive Family Services, Honolulu, HI USA
| | - A Dillard
- />Kula no nā Po‘e Hawai‘i, Honolulu, HI USA
| | - J W Yokota
- />Kōkua Kalihi Valley Comprehensive Family Services, Honolulu, HI USA
| | - D M Palakiko
- />Ke Ola Mamo, Native Hawaiian Health Care System O‘ahu, Honolulu, HI USA
| | - S Gamiao
- />Hawai‘i Maoli of the Association for Hawaiian Civic Clubs, Honolulu, HI USA
| | - C K Hughes
- />Hawai‘i Maoli of the Association for Hawaiian Civic Clubs, Honolulu, HI USA
| | | | - M K Mau
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
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Kroeger CM, Hoddy KK, Varady KA. Impact of weight regain on metabolic disease risk: a review of human trials. J Obes 2014; 2014:614519. [PMID: 25197563 PMCID: PMC4147362 DOI: 10.1155/2014/614519] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/15/2014] [Accepted: 08/04/2014] [Indexed: 02/07/2023] Open
Abstract
Dietary restriction interventions are effective for weight loss and reduction of chronic disease risk. Unfortunately, most people tend to regain much of this lost weight within one year after intervention. While some studies suggest that minor degrees of weight regain have no effect on metabolic disease risk parameters, other studies demonstrate a complete reversal in metabolic benefits. In light of these conflicting findings, it is of interest to determine how complete weight maintenance versus mild weight regain affects key risk parameters. These findings would have important clinical implications, as they could help identify a weight regain threshold that could preserve the metabolic benefits of weight loss. Accordingly, this review examined the impact of no weight regain versus mild regain on various metabolic disease risk parameters, including plasma lipids, blood pressure, glucose, and insulin concentrations, in adult subjects.
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Affiliation(s)
- Cynthia M. Kroeger
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 506F, Chicago, IL 60612, USA
| | - Kristin K. Hoddy
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 506F, Chicago, IL 60612, USA
| | - Krista A. Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor Street, Room 506F, Chicago, IL 60612, USA
- *Krista A. Varady:
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Latner JD, Ciao AC, Wendicke AU, Murakami JM, Durso LE. Community-based behavioral weight-loss treatment: Long-term maintenance of weight loss, physiological, and psychological outcomes. Behav Res Ther 2013; 51:451-9. [DOI: 10.1016/j.brat.2013.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/20/2013] [Accepted: 04/26/2013] [Indexed: 01/02/2023]
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Connolly KK. Addressing healthcare accountability at John A. Burns School of Medicine. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2013; 72:99-101. [PMID: 23520568 PMCID: PMC3602949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kathleen Kihmm Connolly
- Office of Administration, Finance, and Operations, Office of the Dean, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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Kaholokula JK, Townsend CKM, Ige A, Sinclair KIA, Mau MK, Leake A, Palakiko DM, Yoshimura SR, Kekauoha P, Hughes C. Sociodemographic, behavioral, and biological variables related to weight loss in native Hawaiians and other Pacific Islanders. Obesity (Silver Spring) 2013; 21:E196-203. [PMID: 23404724 PMCID: PMC3630234 DOI: 10.1002/oby.20038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 07/09/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. DESIGN AND METHODS Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. RESULTS AND CONCLUSION Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.
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Affiliation(s)
- Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, Center for Native and Pacific Health Disparities Research, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA.
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Izutsu S, Keawe'aimoku Kaholokula J, Lee W, Mau MK, Look M, Carpenter DA, Trask-Batti M, Coen L. Medical school hotline: the Department of Native Hawaiian Health at the John A. Burns School of Medicine. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2012; 71:329-331. [PMID: 23155493 PMCID: PMC3497919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Satoru Izutsu
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, USA
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Kumanyika S. Raising the bar for research to lower the weight of the population. HEALTH EDUCATION & BEHAVIOR 2012; 39:383-5. [PMID: 22843565 DOI: 10.1177/1090198112453464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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King GL, McNeely MJ, Thorpe LE, Mau MLM, Ko J, Liu LL, Sun A, Hsu WC, Chow EA. Understanding and addressing unique needs of diabetes in Asian Americans, native Hawaiians, and Pacific Islanders. Diabetes Care 2012; 35:1181-8. [PMID: 22517939 PMCID: PMC3329823 DOI: 10.2337/dc12-0210] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- George L King
- Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston,Massachusetts, USA.
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