Using a Native Hawaiian Cultural Practice to Prevent Cardiovascular Disease: The Kāholo Project

Introduction: Native Hawaiians are a neglected indigenous population in the U.S. when it comes to being included in health disparities research. Yet, they bear a disproportionate burden of both physical and mental health problems compared to other U.S. ethnic groups, similar to American Indians and Alaska Natives. Regarding cardiovascular disease (CVD) risk, they are 2x more likely (41% to 55%) to have hypertension, 3x to 4x more likely to have heart disease and stroke, respectively, and contract them an average of 10 years younger than non-Hispanic Whites. Thus, they are 68% and 20% more likely to die of CHD and stroke, respectively, than the general population. Cultural grounded interventions for Native Hawaiians can “close the gap” in CVD related disparities.

Methods: Using a community-based participatory approach (CBPR), hula, the traditional dance of Hawai‘i, was explored as a “ground up” intervention to address CVD related disparities in Native Hawaiians and other Pacific Islanders. The development of the hula intervention was done through a series of qualitative (e.g., focus groups and interviews) and quantitative (e.g., metabolic equivalence testing) pilot studies with various community stakeholders and the hula community of practitioners. This lead to a pilot randomized controlled trial, using a waitlist control, to test the efficacy of a hula-based intervention on systolic blood pressure (SBP) reduction in 55 Native Hawaiians and other Pacific Islanders with uncontrolled hypertension (SBP ≥140mmHg).

Results: Participants of the hula-based intervention, called Ola Hou i ka Hula (restoring health through hula), were significantly more likely to show a reduction in their SBP compared to control (−18.3 vs. −7.6 mmHg, respectively, p ≤ 0.05) from baseline to 3-month follow-up. Improvements in measures of bodily pain and social functioning were significantly associated with SBP reductions in both groups. There was a significant decrease in perceptions of ethnic discrimination among participants of the hula intervention only. These preliminary findings were used to secure additional NIH funding to conduct a more definitive intervention study that includes elucidating the psychosocial and sociocultural mediators of the intervention effects on SBP and CVD risk.

Conclusions: Using hula as the core component of a hypertension intervention can serve as a culturally grounded intervention approach to address CVD risk in Native Hawaiians and other Pacific Islanders. This lends support to exploring other traditional indigenous dance forms or other cultural practices for health promotion in other indigenous populations.