Prioritizing Connection and Centering on Community: Take Your Shoes Off and Don't Put Your Feet on the Furniture.

This column describes what it means to be "in" a community and how to create a leading role for community partners in shaping research. It highlights essential components for conducting clinical and translational research in the community, including: (1) invitation to share history and purpose; (2) community-initiated collaboration and engagement; (3) focus on social and cultural determinants of health; (4) community-driven measures and frameworks; (5) application of Indigenous methods and approaches; and (6) implementation of Indigenous and adaptable interventions. Partnering with a community entails building relationships and positioning research around community interests, using methodologies and interventions right for the community.

The Power of Relationships During the Pandemic: A Community Health Center's Response to COVID-19.

This report describes one community health center's response to COVID-19 by integrating Pacific Island (PI) values-which prioritize dignity, agency, and ancestral philosophies-within the context of deep relationship building. We share impacts and insights with the hope this work will resonate with other PI and Indigenous communities.

Anti-racist approaches to increase access to general and oral health care during a pandemic in the Pacific Islander community.

Limited data exists on Pacific Islander (PI) health, but a growing body of literature reports the existence of racial discrimination and inequities and mistrust of the healthcare system, leading to poor health outcomes. When COVID-19 restricted health services, such inequities and mistrust due to historical trauma were magnified. This report describes one federally qualified health center's dental department's response utilizing culture-based approaches, community relationships, and the social determinants of health (SDOH) to dispel the stigma of COVID and restrictions on in-person care in order to lower barriers to accessing care. When the dental department transitioned to emergency-only care, staff were redeployed to address significant inequities facing the PI community. Redeployment activities included building relationships with the most vulnerable patients, delivering healthy foods, supplies, oral hygiene kits to households, and canvasing neighborhood businesses with public health education. The mobile dental clinic, a trusted symbol in the community, also brought public health education to community testing events and food distributions. From March 2020 to July 2020, staff conducted over 800 outreach calls for health and food security, delivered over 2000 care packages and oral hygiene kits. Also, frequent community outreach by the mobile dental clinic led to a 10-fold increase in COVID testing. Investing in relationship building can maintain access to health care and build trust in the health care system for PI communities. This approach may be relevant to others serving other communities experiencing racism.

Understanding the Role of Mental Health Clubhouses in Promoting Wellness and Health Equity Using Pilinaha-An Indigenous Framework for Health.

Individuals with severe mental illness need to be engaged in defining their own vision of wellness to promote equity and reduce disparities. This photovoice study helps define what wellness is and how it is achieved in mental health Clubhouses in Hawai'i. Results from a photovoice study with 43 members and staff were analyzed using Pilinaha, a Native Hawaiian framework for health. Pilinaha envisions health through connection to place, community, past and future, and one's better self. Within Clubhouses, connection to place included connection to 'aina (land) and the access to a safe space. Connection to community occurred through reciprocal social support, which developed kuleana (responsibility), and a sense of 'ohana (family) for many members who were previously isolated. Connection to one's better self-involved positive identity change, development of hope, and pursuing opportunities within and outside the Clubhouse. Connection to past and future was described through individual narratives, remembering members who had died, and connection to cultural traditions. Overall, wellness was conceptualized as the ability to work toward dreams, engage in cultural practice, and feel accepted, respected, and valued-to be treated with aloha. Findings provide a culturally responsive perspective on wellness and illustrate the value of Clubhouses as a space for mental health recovery and transformative change.

Pilinaha: An Indigenous Framework for Health.

This article speaks to the abundance and wisdom of indigenous community members in Kalihi, an urban neighborhood in Honolulu, Hawaii. Its findings result from community members sharing their stories of health, health care, and healing. These stories evolved into a distinct framework for health-Pilinaha or the Four Connections Framework. Pilinaha addresses 4 vital connections that people typically seek to feel whole and healthy in their lives: connections to place, community, past and future, and one's better self. This article describes the origins, intent, key concepts, and implementation of this framework. By doing so, the authors hope to add to the growing body of work on community and indigenous well-being, further the dialogue with other indigenous communities, and collectively foster a more meaningful and effective health system for all.

Pedals and Pedagogy: Cycles of Hope and Health.

The Kalihi Valley Instructional Bike Exchange (KVIBE) is an innovative youth bike program housed in Kokua Kalihi Valley Family Comprehensive Services (KKV), a community health center in Honolulu, Hawai'i. KVIBE utilizes a popular education model to raise the social consciousness of its youth participants, who are primarily working class, Indigenous, and native to the Philippines or the Pacific Islands, especially Micronesia. Initially designed as a bike repair program where youth could earn a bicycle through sweat equity, KVIBE has grown into an educational space that teaches bicycle mechanics as well as personal history and identity. The KVIBE curriculum incorporates a social determinants of health approach with the Four Connections Framework, an Indigenous health framework developed by KKV and the Islander Institute. This article shares details of this program, as a pedagogical model for programs to engage underserved and marginalized Asian, Pacific Islander and Native Hawaiian youth who suffer from displacement and historical trauma via colonization. Additionally, this article speaks to the importance of seeing marginalized youth not as an at-risk group but as agents in creating community health.

Health care needs of the homeless of O'ahu.

An interview study of 162 homeless individuals on O'ahu demonstrated that the homeless studied were 3 times more likely than the general population of O'ahu to rate their health as fair to poor, despite the fact that 77% of interviewees had medical insurance and 66% a regular health care provider Better self ratings of health were only associated with younger age and self report of having dental insurance when demographic variables were controlled for. Qualitatively the homeless population interviewed described 'good health' as avoiding illness and being able to make healthy lifestyle choices, finding emotional balance and caring for others. Commonly reported barriers to accessing care included financial factors such as being unable to purchase medications; environmental challenges such as clean drinking water and a safe place to stay; and general discomfort with the health care system. Clinical implications of this study indicate the need for providers caring for the homeless be alert to challenges particular to the homeless, such as barriers to following medical advice (high fiber/low salt diet, exercise, refrigerating medications, etc.). The surprising relationship between knowledge of having dental insurance and better self ratings of health deserves additional research, as does the lack of association between health ratings and having health insurance and a regular provider.

Using problem-based learning for pandemic preparedness.

To test the hypothesis that PBL is an effective method for preparing multidisciplinary learner groups at community health centers (CHCs) for pandemics, quantitative and qualitative methods were utilized to evaluate the conduct of a PBL case of a hypothetical outbreak of severe acute respiratory syndrome (SARS) at two CHCs in Hawaii, with multidisciplinary health professional and student participants. It was found that: (1) there was an overall increase in knowledge of bioevent preparedness; (2) participants gave high ratings for the effectiveness of the PBL process; (3) participants found value in the multidisciplinary group process; and (4) participants strongly agreed that they preferred the PBL process to the traditional lecture format for learning about bioevent preparedness. The PBL approach is useful in educating community-based health professionals from different disciplines about issues related to pandemic preparedness.

Evaluation of distance learning for health education.

The Hawai'i Unified Telehealth program is a distance learning health education program for rural communities, created with federal grant funding from the U.S. Department of Commerce and the National Institutes of Health. These grant funds helped develop a network of rural community learning centers that employ distance learning technologies to provide community-driven peer education to isolated areas across Hawai'i and Majuro, Republic of the Marshall Islands. In this article, the authors briefly describe the development of the ongoing health education program and the results of outcome evaluation completed at the end of the funding period.