Neighborhood level facilitators and barriers to hypertension management: A Native Hawaiian perspective.

Native Hawaiians have a disproportionately high prevalence of hypertension, which is an important and modifiable risk factor for cardiovascular disease (CVD). To reduce CVD among Native Hawaiians, we must better understand facilitators and barriers to hypertension management (i.e., diet, physical activity, stress reduction) unique to Native Hawaiians. Despite evidence of neighborhood-level facilitators and barriers to hypertension management in other populations, there is limited research in Native Hawaiians. Participants from a randomized controlled trial (n = 40) were recruited for 5 focus groups. All participants were self-reported Native Hawaiians and had uncontrolled hypertension. Discussions elicited experiences and perceptions of neighborhood-level stressors as they relate to participants' hypertension management efforts. Audio recordings were transcribed and analyzed using ATLAS.ti for emergent themes. Five themes were identified: neighborhood description, community resources, neighborhood change, safety, and social connectedness. Novel barriers to hypertension control included loss of culture and loss of respect for elders, change in community feel, and over-development. Facilitators included social cohesion and collective power. These data provide a deeper understanding of how Native Hawaiians experience neighborhood factors and how those factors impact their efforts to improve their diets, physical activity, and stress management. The findings help to inform the development of multilevel CVD prevention programs. Further research is needed to explore the subtheme of social and emotional stress related to neighborhood change and CVD health risk due to cultural and historic trauma references.

Reclaiming 'Aina Health in Waimanalo.

Kanaka Maoli (Native Hawaiian) worldviews of health emphasize pono (righteousness) and lokahi (balance), which extends to include relationships with other people, akua (spiritual realm), and 'aina (land). The purpose of this qualitative study was to explore the role of 'aina and 'aina connection in health and resilience based on the perspectives of 12 Kanaka Maoli adults from the Waimanalo community. Three major themes were identified: 'Aina is everything, 'aina is health, and community healing through community-led initiatives. A better understanding of 'aina connection is important to improve our knowledge of Hawaiian health. A connection to 'aina may specifically address health concerns resulting from historical trauma and environmental changes.