Culturally Relevant Prevention Interventions for Native Hawaiians: A Systematic Review of the Literature

Background and Purpose: Epidemiological health research indicates that Native Hawaiians disproportionately suffer from physical and mental health conditions, such as obesity, diabetes, chronic kidney disease, suicidal behaviors, and substance abuse. Historically, research has lagged in terms of developing effective, culturally relevant interventions to address these and other pervasive health disparities among Native Hawaiian populations. Recently, however, this lack of empirically supported interventions is being addressed through specific requests for research proposals from the National Institutes of Health and other grant-funding agencies. In order to examine the current impact of broad systemic efforts to expand and develop the intervention literature, this study systematically reviewed the recent culturally relevant prevention intervention literature focused on Native Hawaiians.

Methods: In Step 1, a computerized search of online databases was conducted, encompassing the years 2015-2020, as well as a focused search of 13 journals that have a history of publishing research focused on Native Hawaiians. The online database search yielded 483 articles, and the focused journal search yielded 344 articles. After eliminating duplicates, there were 473 unique articles for potential inclusion in the review. In Step 2, the number of articles was reduced to 34 after all abstracts were read and evaluated based on specific inclusionary and exclusionary criteria. In Step 3, the full text of the 34 remaining articles were assessed, and the final number of articles was reduced to 14.

Results: The final data set was comprised of 14 recent, peer-reviewed empirical studies of culturally grounded or adapted Hawaiian-focused prevention interventions. These 14 studies evaluated 10 different culturally relevant interventions which were primarily focused on substance use (33%), obesity/diabetes (20%), and pregnancy/sexually transmitted infections (20%). Half of the studies used culturally grounded methodologies to develop programs or curricula based upon the values, beliefs, and worldviews of Native Hawaiian communities. The remaining studies used deep-structure cultural adaptations of evidence-based curricula to meaningfully infuse cultural content and context into their interventions.

Conclusions and Implications: Compared with prior, related literature reviews (1995-2004 and 2003-2014), the present review suggests an overall advancement in prevention science for Native Hawaiians. This advancement is evidenced by an increase in federal funding and an increase in randomized controlled clinical trials. Despite these advances, however, notable areas of future research emerged. There were a lack of culturally relevant prevention studies related to mental health (e.g., suicidality), and some chronic physical conditions (e.g., kidney disease). Further, the majority of the studies took place in the State of Hawai‘i, therefore much is still not known about the needs of Native Hawaiians living in the Continental U.S. Finally, only two of the studies were written by self-identified Native Hawaiian researchers as lead authors. This highlights the fact that the scientific workforce lacks Native Hawaiian prevention researchers who are able to contribute to culturally relevant prevention development and evaluation. Future federal efforts should work toward developing both Native Hawaiian prevention science and the Native Hawaiian scientific workforce.