Mele A. Look, Claire Townsend , Sheryl Yoshimura, Edna Baldado,

1. Prevention & Treatment Models for Multi-cultural Populations Mele A. Look, Claire Townsend , Sheryl Yoshimura, Edna Baldado, Diabetes in Asian Americans, Native Hawaiians and Pacific Islanders: A Call to Action September 30, 2011 Honolulu, Hawai‘i

2. PILI ‘Ohana & Land, Food & Health • Native Hawaiian and other Pacific People • Developed through Community-Based Participatory Research (CBPR) framework • Culturally grounded for the participant population • Utilizes community health worker staffing to achieve cost efficiencies

3. Academic Co-Director Keawe Kaholokula Community Co-Director Donna Palakiko Community Advisory Board Project Leadership and Administrative Support Kalihi-Palama CHC Community PI: Anne Leake Kula no Nā Po‘e Community PI: Puni Kekauoha Kokua Kalihi Valley Community PI: Sheryl Yoshimura Ke Ola Mamo Community PI: Donna Palakiko Hawai‘i Maoli Community PI: Claire Hughes Native Hawaiian Health Academic PI: K. Kaholokula & Marjorie Mau Project Coordinator Claire Townsend Graduate Research Assistants Chelsea Okamoto Arlene Ige Who is the PILI ‘Ohana Partnership?

4. PILI `Ohana Lifestyle Intervention (POLI) Development • Based on the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) . • Focus groups, informant interviews, windshield tours, surveys were conducted • Qualitative data analyzed to include culural the intervention development

5. Data from 333 NHs and PPs • 112 focus group participants • 15 community informants • 206 survey respondents. • “Windshield tours” • Social/Community Influences • Healthy food and physical activity options/resources • Cultural eating/weight expectations • Cost of healthy food options • Availability of cultural activities • Community leaders/ advocates • Family Influences • Family dynamics/stress • Family eating habits • Availability of certain foods in home • Family activities • Household income • Childcare • Individual Influences • Self-efficacy/locus of control • Past weight management attempts • Weight loss expectations • Assertiveness • Stress/time management Weight Loss Maintenance Gathering Community Input* *In: Mau, MK et al. (2010). Translating Diabetes Prevention into Native Hawaiian and Pacific Islander Communities: The PILI ‘Ohana Pilot Project. Progress in Community Health Partnerships: Research, Education, and Action, 4(1), 7-16.

6. Putting It to the Test • Pilot intervention study • 2-Arm randomized controlled trial (RCT) 468 Respondents screened 372 Eligible to participate 277 Consented and underwent baseline assessment 169 Received 3-month weight loss intervention 144 Completed 3-month follow-up and underwent randomization 72 Assigned to family/ community-focused weight loss maintenance intervention group 72 Assigned to standard phone call follow-up group 49 Completed 9-month follow-up 51 Completed 9-month follow-up

7. Family plus community weight loss maintenance program (n= 49) Standard phone call follow-ups (n = 51) * Indicates statistical significance (p  .05) compared to baseline How Does it Look Overall? Change in weight (kg) Change in physical functioning based on 6 min. walk test

8. 3-Year Pilot Outcomes & Lessons Learned • Culturally-adapted and translated the DPP intervention into NH/PI communities. • A family and community focused intervention to prevent weight regain is superior to standard behavioral follow-up. • CBPR can be effective in conducting RCTs. • Communities can deliver their own health intervention and with significant outcomes.

9. Land, Food & HealthAloha ‘Āina Mālama‘Āina Hauloli‘i, by Carl Frankin Ka‘aila‘au Pao

10. Community Programs Land, Food, Health & Diabetes • O‘ahu: Kokua Kalihi ValleyHealth Center • Healthy Eating & Lifestyle Program • O‘ahu: Waikiki Health Center: • Hua o Laulima • Hawai‘i Island: Hui Mālama Ola na ‘Ōiwi: • Mai ka Mala ‘Ai • Maui: Hui no ke Ola Pono: • Laulima Project • Moloka‘i: Na Pu‘uwai • O ka Mamo ke Kaiao

11. Culture-Based Education Language, Cultural content, Cultural context, ‘Ohana & community, Assessment Socio-Emotional Development Self-worth, Cultural identity, Family & community relations Outcomes Engagement, Achievement, Behavior Hawaiian Cultural Influences in Education Theoretical Model Source: Kanai’aupuni S, Ledward B, Jensen U, Culture-based education and its relationship to student outcomes. Honolulu: Kamehameha Schools, Research & Evaluation Division. 2010

12. Culture-Based Education and Diabetes Self-Management Education

13. Applying Best Practices for Diabetes Self-Management Programs

14. Healthy Eating Lifestyle Program (HELP)

15. Mai ka Mala‘ai

17. Probable Success Factors • Cultural resonance • Empowerment • Social Support • Learning Environment

18. Mahalo piha • Aloha and mahalo are tendered to the Papakolea Homestead Community, Association of Hawaiian Civic Clubs, Kalihi-Palama Community Health Center, Ke Ola Mamo, Hui Mālama Ola na ‘Ōiwi and Kokua Kalihi Valley Comprehensive Health Center, and the Center for Native and Pacific Health Disparity Research. This presentation was made possible in part by Award Number P20MD000173 and R24MD001660 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center on Minority Health and Health Disparities or the National Institutes of Health.