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This resource paper draws lessons from a twenty-year partnership between the Native Hawaiian community of Papakōlea, the Hawai‘i Alliance for Community-Based Economic Development, and the Department of Urban and Regional Planning at the University of Hawai‘i. Key players and co-authors describe five principles for sustained partnerships: (1) building partnerships based upon community values with potential for long-term commitments; (2) privileging indigenous ways of knowing; (3) creating a culture of learning together as a co-learning community; (4) fostering reciprocity and compassion in nurturing relationships; and (5) utilizing empowering methodologies and capacity-building strategies.

Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the United States. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research approach. Adult Pacific Islanders (N = 144) were randomly assigned to either PLP (n = 72) or SBP (n = 72) after completing a 3-month weight loss program. Successful weight maintenance was defined as participants' postintervention weight change remaining less than or equal to 3% of their preintervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p less than or equal to 0.05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% confidence interval = 1.06, 24; p = 0.02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity disparities of Pacific Islanders and thus warrants further investigation. (Contains 1 figure and 5 tables.)

Purpose/Background: Understanding the concerns and challenges of caregivers of Native Hawaiian kūpuna or elders (age 55 years and older) with age-related memory loss conditions, specifically, Alzheimer's Disease and Related Dementia (ADRD), on one Hawaiian Homestead is the focus of this translational research study. The goal of this research is to identify factors affecting the safe and compassionate care for kūpuna preferring to agein- place. In Native Hawaiian communities, it is culturally appropriate to care and support kūpuna who wish to age-in-place. This study was conducted in Papakōlea, a Native Hawaiian Homestead community consisting of three subdivisions in the city of Honolulu, located on the island of O'ahu using a cultural safety praxis. The literature on caregiving in the context of ADRD indicates that caregivers often are concerned about the safety of their elders in the home and wonder if they are "doing enough" to care for their loved one. As a result of their historical struggles, residents of Papakolea place an emphasis on supporting and caring for kūpuna who wish to age-in-place. However, families voiced concerns of not being equipped to provide their kūpuna quality care. Materials & Methods: This research is grounded in Community-Based Participatory Research (CBPR) principles and utilizes a mixed methods strategy to assess the needs and concerns of caregivers of Papakōlea. The study focuses on identifying the needs, knowledge, attitudes, and resources that enable or disable caregiving with a view toward informing care within the designated homestead community. The quantitative arm of the study involved development and administration of a written survey eliciting sociodemographic characteristics, as well as, knowledge-attitudes-behaviors on caregiving. The qualitative arm of the study involved focus groups to clarify and extend information learned through survey data. Participants of the study were self-identified current and former caregivers, age 18 and older, experienced in caring for kūpuna with conditions associated with age-related memory loss (e.g., ADRD). Results: Approximately 92% of participants identified as Native Hawaiian (n=155). Ages ranged from 18 to 82 years (M = 51.22, SD 16.347). The results indicate that current and former caregivers provide care primarily to their mothers 41% (n=48), fathers 11% (n=13) and grandparents 21% (n=25). The number of kūpuna diagnosed with ADRD was 48% (n=42), about 52% (n=49) believed they cared for someone with ADRD even though they have not received a diagnosis from a physician. Caregivers identified the need for family conversations on advance health care directives before a medical emergency and respite support as primary concerns. Discussion/Conclusion: This study focused on Native Hawaiians, a marginalized population and the need to provide relevant ADRD services. Findings are used to assist this homestead community in determining the types of resources and support essential to mitigate caregiver burnout while simultaneously providing services to enhance kūpuna care while using HILINA'I concepts to continue to build trust and cultural safety using a research praxis (figure 1). There are differences between homestead communities across the state in the expression of Hawaiian values and practices and degrees of community resilience. Therefore, this study may not be representative of all homesteads statewide. [ABSTRACT FROM AUTHOR]

Discrimination is an acute and chronic stressor that negatively impacts the health of many ethnic groups in the United States. Individuals who perceive increased levels of discrimination are at risk of experiencing psychological distress and symptoms of depression. No study to date has examined the relationship between perceived discrimination and mental health in Native Hawaiians. The purpose of this study is to explore the relationship between perceived discrimination and depression based on the Homestead Health Survey mailed to Native Hawaiian residents of Hawaiian Home Lands. This study also explores the role of cultural identity and how it may impact experiences of discrimination and symptoms of depression. Based on cross-sectional data obtained from 104 Native Hawaiian residents, a significant positive correlation was found between perceived discrimination and symptoms of depression (r= 0.32, P<.001). Cultural identity did not significantly correlate with discrimination or depression. Multiple linear regression analyses indicate that the relationship between depression and discrimination remained statistically significant (coefficient estimate of 0.18; P<.01), after accounting for differences in socio-demographics and degree of identification with the Native Hawaiian and American cultures. These findings are consistent with other studies that have focused on the effects of discrimination on psychological wellbeing for other ethnic minority populations. [ABSTRACT FROM AUTHOR]

Cultural safety is a strengths-based construct which aims to subvert unequal power relations, honor diverse ways of knowing in community-specific contexts, and acknowledge community as arbiter of 'how' safety is actualized. Published literature documents the benefits of culturally safe healthcare yet pays scant attention to culturally safe research praxis. Our team of practitionerresearchers sought to uncover meanings of cultural safety in community-based health research with Hawaiian Homestead residents. Focus groups were conducted in three communities. Emic descriptions of cultural safety and non-resident researchers were elicited. Content analysis revealed trust (hilina'i) as the overarching theme fundamental to cultural safety. Cultural safety was demonstrated by practices that accommodate and engage community in their shared sense of place, history, ways of knowing, and capacity-building. Such practices likely mitigate perceptions of cultural imposition and promote relevant interventions developed with communities. Implications are enunciated in HILINA'I, a mnemonic for advancing knowledge decolonization and health equity. [ABSTRACT FROM AUTHOR]

Community-based participatory research (CBPR) is an approach to scientific research that is gaining broader application to address persistent problems in health care disparities and other hypothesis-driven research. However, information on how to form CBPR community-academic partnerships and how to best involve community partners in scientific research is not well-defined The purpose of this paper is to share the experience of the Partnership for Improving Lifestyle Interventions (PILI) 'Ohana Project in forming a co-equal CBPR community-academic partnership that involved 5 different community partners in a scientific research study to address obesity disparities in Native Hawaiians and other Pacific Peoples (l e . Samoans. Chuukese, and Filipinos). Specifically, the paper discusses 1) the formation of our community-academic partnership including identification of the research topic; 2) the development of the CBPR infrastructure to fester a sustainable co-equal research environment: and 3) the collaboration in designing a community-based and community-led intervention. The paper concludes with a beef summary of the authors' thoughts about CBPR partnerships from both the academic and community perspectives. [ABSTRACT FROM AUTHOR]

Papakolea, the only Native Hawaiian (NH) homestead community located in urban Honolulu, has one of the highest proportions of NHs living in a single geographic area. Despite prior attempts dating back to the 1920s to improve the health of the community, many health disparities remain within the Papakolea community. This is the story of how the Papakolea community decided to confront the health of its community by integrating Hawaiian and Western healing arts. The purpose of this "Case Report from the Field" is to share the journey the Papakolea community started back in 1992 to build capacity within their own community by forming its first 501c3 community based non-profit organization entitled Kula no na Po'e Hawai'i (referred to as Kula). Through Kula, a unique traditional healing training program was started called Na Lomilomi O Papakolea (NLOP). NLOP became the first self-sustaining health program for training lomilomi practitioners (traditional NH therapeutic massage) in the Papakolea community. This case report describes how lomilomi practitioners and medical practitioners began sharing their skills and expertise to heal their clients and in the process began to heal the community itself. The purpose of this paper is to describe their journey with the intent of sharing how one dedicated group of people has been successful in healing their community and is now on the road to better health and sustained well being by working together. [ABSTRACT FROM AUTHOR]