Reclaiming 'Āina Health in Waimānalo

"I Need to Get My Culture Back": Youth and Provider Perspectives on Integrating Culturally Based Approaches into Sexual and Reproductive Health Programs for Native Hawaiian and Pacific Islander Youth Experiencing Homelessness

There is growing interest in decolonizing sexual and reproductive health (SRH) and embedding cultural practices into social and medical services in Hawai'i. Wahine ("woman") Talk is a multilevel, comprehensive SRH program for female youth experiencing homelessness (YEH) led by community health, social work, and medical providers. This study examines youth and program provider perspectives of culturally based approaches that may strengthen SRH programs. The study team conducted three focus groups and ten in-depth interviews with participating youth and program providers after the program's conclusion. Youth participants were aged 14 to 22 years (M = 18.1) and of Native Hawaiian or Pacific Islander ancestry. Interview transcripts were analyzed using structured thematic analysis. The youth described feeling estranged from their ancestral cultures and suggested incorporating multiple cultural practices to enhance their connection to community, body, and land into SRH programming for YEH. They identified several 'āina ("land")-based approaches, hands-on learning, hula, and language as possible practices to weave into the program. While youth felt estranged from their ancestral cultures, they discussed Native Hawaiian and Pacific Islander health perspectives where 'āina and relationships are considered life-sustaining. Youth and program staff stressed incorporating culture respectfully, caring for the whole person, and providing trauma-informed care. Future policy, practice, and research should consider protecting and integrating Native Hawaiian conceptions of health into SRH policy and practice and include youths' cultural identities in SRH intervention development.

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.

What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada

Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.

A Report on the Ke Ola O Ka 'Āina: 'Āina Connectedness Scale

Optimal health from a Native Hawaiian worldview is achieved by being pono (righteous) and maintaining lōkahi (balance) with all our relations, including our relationships as Kānaka (humankind) with 'Āina (land, nature, environment, that which feeds) and Akua (spiritual realm). The purpose of this study is to explore the role of 'Āina connectedness in Native Hawaiian health and resilience to inform the development of the 'Āina Connectedness Scale. Qualitative methods were conducted with 40 Native Hawaiian adults throughout Hawai'i. Three themes emerged: (1) 'Āina is everything; (2) Connection to 'Āina is imperative to health; and (3) Intergenerational health, healing, and resilience are reflected through intergenerational connectedness with 'Āina. Qualitative findings, supplemented with a scoping review of land, nature, and cultural connectedness scales, led to the development of the 'Āina Connectedness Scale, which examined the degree to which people feel connected to 'Āina, with implications for future research. 'Āina connectedness may address concerns related to health disparities that stem from colonization, historical trauma, and environmental changes and better our understanding of Native Hawaiian health by fostering stronger ties to land. Resilience- and 'Āina-based approaches are critically important to health equity and interventions that aim to improve Native Hawaiian health.

Just data representation for Native Hawaiians and Pacific Islanders: A critical review of systemic Indigenous erasure in census and recommendations for psychologists

The decennial Census survey marks the emergence of federal classifications of race and ethnicity by which the U.S. government has historically conflated Native Hawaiians and Pacific Islanders (NHPI, hereafter) as "Asian or Pacific Islander." This conflation amplifies health injustices and inequities of NHPIs through multiple mechanisms because it masks the complex and heterogeneous experiences of NHPIs, whose positions and relations with the settler state are qualitatively and substantially distinct from Asian Americans. This critical review examines federal documents and research to examine how the panethnic categorizations are often sustained through scientific inquiry and methodologies. We found that self-determination and self-identification for NHPIs are impeded by settler-colonial relations between U.S. colonization of parts of Oceania (e.g., Hawai'i, Sāmoa, Fiji, and Guam) and the forcefully imposed categorization that continues to be in use to legitimize the domination of Indigenous Peoples through race misclassification. Specifically, Census data collection fails to capture accurate and reliable data due to serious methodological limitations. These implications for psychological research compel us to make several recommendations for psychologists: (1) engage with NHPI community partners in all research processes; (2) critically examine Census research design and consider oversampling NHPI households to ensure just data representation; (3) meaningfully engage when, whether and how to aggregate Asian Americans with NHPIs; and (4) use Indigeneity as a critical framework.

Insights in Public Health: Ask the Keiki: Perceived Factors that Affect Asthma Among Adolescents from the Wai'anae Coast Using Photovoice

Hawai'i has among the highest childhood asthma prevalence compared to all other states in the United States. Native Hawaiian children have a higher prevalence of asthma compared other racial/ethnic groups in the state. Photovoice is a method in community-based participatory research that enables participants to use photos to express themselves and advocate on behalf of their community. In this study, students from the Wai'anae Coast used Photovoice to identify perceived factors that affect asthma management. Seven students, ages 14 and 18, with self-reported asthma met virtually, with facilitators, after school once a week for four weeks. Students identified eight factors as positively or negatively impacting the students' asthma and explained how these factors influence their health. The Photovoice results provided an in-depth understanding on the role a student's culture and environment plays in asthma management. Continued efforts to develop asthma education programs tailored to address the specific factors that youth identify as impacting their asthma may be more effective in reducing asthma disparities. Future research should expand on the key themes identified in this study and include continued advocacy efforts among students to improve asthma-related outcomes in this community.

A Scoping Review of Nature, Land, and Environmental Connectedness and Relatedness

The importance of nature and the environment in relation to human health is coalescing, as demonstrated by the increased research that attempts to measure nature connectedness and relatedness. These findings align with constructs of cultural connectedness that assess for land connectedness as part of Indigenous ways of knowing. From an Indigenous worldview, relationships with the environment are critical to wellbeing. The purpose of this comprehensive systematic scoping literature review was two-fold: (1) identify and summarize existing measures of land, nature, and/or environmental connectedness, relatedness, and attitudes and (2) evaluate the psychometric properties of these scales. In total, 1438 articles were retrieved from select databases including PubMed/MEDLINE, PsycINFO, CINAHL (EBSCO), and Academic Search Complete (EBSCO). The final searches and application of the inclusion/exclusion criteria resulted in 57 unique articles and 38 scales categorized as connectedness and relatedness scales (n = 9 scales), attitudinal and values-based scales (n = 16 scales), cultural and spiritually based scales (n = 9 scales), and paradigm-based scales (n = 4 scales) (articles could be placed in multiple categories). Psychometric properties and general outcomes associated with nature-related scales are reported, with implications for future education, research, practice, and policy.