Culturally Focused Interventions for Native Hawaiians: A Systematic Review

Background and Purpose:

In modern Hawaiʻi, there is an alarming and disproportionate representation of kānaka maoli, the indigenous people of the Hawaiian Islands, as a “failing” population.  Like other indigenous cultures and ethnic minorities, Native Hawaiians (NH) experience disproportionate rates of health disparities, social problems, mental health issues, homelessness, poverty, crime, suicide, family violence, and substance abuse disorders compared to other ethnic majority groups.  The abundance of such difficulties indicates just how urgently social work interventions are needed among the NH population and how the key to improving NH health and well-being is to promote culturally focused interventions to support their ability to flourish in ways that speak to them.

The literature on culturally focused interventions for NH is growing; however, a systematic review of the existing literature documenting the cultural components, targeted audiences and focus areas, and research designs and outcomes is needed. The purpose of this article is to (a) present a review of the literature focusing on culturally focused interventions as it relates to health and well-being of NH and (b) identify limitations and gaps to promote future research. 

Methods:

This systematic review applied a Boolean search mode using the following search terms: Native Hawaiian AND culture AND intervention, and was conducted through EBSCOhost, Google Scholar, PsychInfo, PubMed, Social Sciences Abstracts, and Social Work Abstract electronic databases. The target population (i.e., the audience intended to benefit from the culturally focused intervention) had to be described as Native Hawaiians; however, studies that did not disaggregate data so that Native Hawaiians were considered separately from NH and other Pacific Islanders were still included.  Only articles reporting on the results of an original culturally focused intervention for NH were include; studies detailing the pre-intervention activities, post intervention follow-ups, intervention reviews (i.e., literature reviews or summaries about intervention[s]), or needs assessments were excluded.  After abstracts were screened using these criteria, 17 articles remained and were included in the study.

Results:

The cultural components utilized in the interventions were found to vary in description and type; where some studies were general in describing the cultural components, others provided rich descriptions.  The particularized cultural components included ‘ohana (family and community), spirituality, kuleana (responsibility), haʻaheo (pride), cultural knowledge (i.e., NH history and culture), mālama ʻāina/ kai (use of and/ or caring for the physical environment), meaʻai (food), hula (dance), ʻōlelo Hawai‘i (Hawaiian language) and ʻōlelo noʻeau (proverbs).  Few studies justified how the cultural components were relevant to the intervention, and even fewer studies measured the impacts of the cultural components.  Most of the interventions were obesity related, and majority were designed for adults.  Most of the studies utilized a randomized control trial design, and most utilized community based participatory research methods.  All of the studies reported positive results, and majority applied statistical analysis on quantitative measures.

Conclusions and Implications:

This study enriches the field of study for researchers by building awareness, encouraging collaboration, and identifying where culturally focused intervention efforts are underdeveloped or nonexistent to provide direction for intervention development.