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Fernandes R.,Kokua Kalihi Valley Comprehensive Family Services | Braun K.L.,University of Hawaii at Manoa | Spinner J.R.,U.S. National Institutes of Health | Sturdevant C.,Kokua Kalihi Valley Comprehensive Family Services | And 5 more authors.
Journal of Health Care for the Poor and Underserved

Kokua Kalihi Valley, a federally qualified health center in Hawaii, collaborated with the National Heart, Lung, and Blood Institute to test the efficacy of community health workers (CHWs) to deliver the Healthy Heart, Healthy Family curriculum to low-income Filipinos with cardiovascular disease (CVD) risk factors. At 12 months, significant improvements were seen in health behaviors, knowledge, and self-efficacy in managing chronic diseases. We also observed decreases in total cholesterol from 186.25 mg/dl to 170.88 mg/dl (p5.001), low-density lipoprotein from 114.43 mg/dl to 103.04 mg/dl (p5.013), and fasting blood glucose from 117.95 mg/dl to 109.07 mg/dl (p5.034). Although these changes were statistically significant, they are small and not clinically meaningful in reducing CVD risk. The high-density lipoprotein was 3.3 mg/dl lower (worse) at 12 months (p5.003), mean values for blood pressure, BMI, and waist circumference increased. Community health workers can be trained to deliver evidence-based curricula that improve health behaviors and increase self-efficacy in managing chronic diseases. © Meharry Medical College. Source

Tomioka M.,University of Hawaii at Manoa | Braun K.L.,University of Hawaii at Manoa | Compton M.,Kokua Kalihi Valley Comprehensive Family Services | Tanoue L.,ALU LIKE Inc.

Purpose of the study: Stanford's Chronic Disease Self-Management Program (CDSMP) has been proven to increase patients' ability to manage distress. We describe how we replicated CDSMP in Asian and Pacific Islander (API) communities. Design and Methods: We used the "track changes" tool to deconstruct CDSMP into its various components (e.g., recruitment and staffing) and the "adaptation traffic light" to identify allowable modifications to the original program. We monitored local leaders' fidelity of delivery of CDSMP and tracked participants' attendance, satisfaction, and 6-month outcomes. Results: Between July 2007 and February 2010, 584 completed a CDSMP workshop. Baseline and 6-month data were available for 422 (72%), including 53 Caucasians, 177 Asians, and 194 Pacific Islanders. All 3 groups realized significant decreases in social and role activity limitations and significant increases in communication with physicians. Asians and Pacific Islanders also realized significant increases in self-rated health and time spent engaging in stretching/strengthening exercise. Asians also reported significant reductions in health distress and self-reported physician visits and increases in time spent in aerobic exercise, ability to cope with symptoms, and self-efficacy. Implications: Our experience suggests that CDSMP can be modified for increased cultural appropriateness for API communities while maintaining the key components responsible for behavior change. © The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. Source

Chung-Do J.J.,University of Hawaii at Manoa | Look M.A.,University of Hawaii at Manoa | Mabellos T.,University of Hawaii at Manoa | Trask-Batti M.,University of Hawaii at Manoa | And 2 more authors.
Progress in Community Health Partnerships: Research, Education, and Action

Background: Health disparities continue to persist among Native Hawaiian and Pacific Islander (NHPI) communities. Objectives: This study sought to understand the perspectives of community organizations in the Ulu Network on how researchers can collaborate with communities to promote community wellness. Methods: Key informant interviews and small group interviews were conducted with the leadership in the Ulu Network. Results: Five themes were identified that highlight the importance of investing time and commitment to build authentic relationships, understanding the diversity and unique differences across Pacific communities, ensuring that communities receive direct and meaningful benefits, understanding the organizational capacity, and initiating the dialog early to ensure that community perspectives are integrated in every stage of research. Conclusions: Increasing capacity of researchers, as well as community organizations, can help build toward a more equitable and meaningful partnership to enhance community wellness. © 2016 The Johns Hopkins University Press. Source

Townsend C.K.M.,University of Hawaii at Manoa | Dillard A.,Kula No Na Poe Hawaii | Hosoda K.K.,University of Hawaii at Manoa | Maskarinec G.G.,University of Hawaii at Manoa | And 6 more authors.
International Journal of Environmental Research and Public Health

Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai‘i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes. The purpose of this paper is to describe the community-based participatory research (CBPR) approach and research process we employed to integrate behavior and biological sciences with community health priorities. A CBPR approach was used to test a 3-month evidence-based, diabetes self-management intervention (N = 65). To investigate the molecular mechanisms linking inflammation with glucose homeostasis, a subset of participants (n = 16) provided peripheral blood mononuclear cells. Community and academic researchers collaborated on research design, assessment protocols, and participant recruitment, prioritizing participants’ convenience and education and strictly limiting the use of the data collected. Preliminary results indicate significant changes in DNA methylation at gene regions associated with inflammation and diabetes signaling pathways and significant improvements in hemoglobin A1c, self-care activities, and diabetes distress and understanding. This study integrates community, behavioral, and epigenomic expertise to better understand the outcomes of a diabetes self-management intervention. Key lessons learned suggest the studies requiring biospecimen collection in indigenous populations require community trust of the researchers, mutual benefits for the community and researchers, and for the researchers to prioritize the community’s needs. CBPR may be an important tool in providing communities the voice and protections to participate in studies requiring biospecimens. © 2015 by the authors; licensee MDPI, Basel, Switzerland. Source

Kaholokula J.K.,University of Hawaii at Manoa | Mau M.K.,University of Hawaii at Manoa | Leake A.,University of Hawaii at Manoa | West M.,University of Hawaii at Manoa | And 4 more authors.
Health Education and Behavior

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 ≤3% of their preintervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p ≤ .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 = .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. © 2012 Society for Public Health Education. Source

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