Staff at the Rawmana Fitness Center join community health navigator Coral Kenolio (second from right) in preparation for the CTRI-supported Pacific Islander health pilot study.
March 22, 2016 | Patti Wieser
Sharing a good story could be the start toward better health.
Researchers supported by the UC San Diego Clinical and Translational Research Institute (CTRI) are employing Talk Story – the tradition of sharing stories – in a study to increase physical activity through a culturally tailored, community-led intervention among Pacific Islanders and Native Hawaiians.
“The study has two components: health training and leadership training,” said Christina Holub, PhD, MPH, one of the principal investigators on the CTRI-supported academic-community pilot project. “The format of the leadership group is actually Talk Story, a tradition among Native Hawaiians and Pacific Islanders who place a high value on passing down knowledge through stories and preserving culture.”
Holub, a researcher at San Diego State University (SDSU), joins co-principal investigator Camille Nebeker, EdD, MS, of the UC San Diego Department of Family Medicine and Public Health, and community partner Siaosi Veimau of Rawmana Fitness in the study.
Siaosi Veimau of Rawmana Fitness
The primary goal is for participants in the 12-week intervention to increase their physical activity level and intensity to meet recommendation guidelines for adults (i.e. 150 minutes of moderate-to-vigorous physical activity per week). Culturally-inspired activities include canoe paddling and traditional dance. The overarching goal is to foster an academic-community relationship with Rawmana Fitness, and prepare the organization for future full-scale research and collaboration. “Rawmana, native owned by a Tongan family, is helping train community health workers to assist with delivering the intervention itself,” Holub said.
The pilot is the direct result of an earlier community-based participatory research formative study in which researchers worked alongside the Pacific Islander community in San Diego to identify health concerns, potential culturally-relevant strategies, barriers and solutions, and other community needs. “We found that obesity and diabetes were top concerns for the community,” said Holub, who is affiliated with SDSU’s Institute for Behavioral and Community Health (IBACH).
“The idea behind community-based participatory research is that the community is driving the bus. They are the ones who provide the research questions and help with the intervention,” said Nebeker, who was responsible for training community health workers about scientific methods and ethical research practices prior to the intervention. She used a program she co-developed called BRIC – Building Research Integrity and Capacity – to introduce fundamental elements of the scientific method and responsible conduct of research involving human subjects. For the BRIC innovation, Nebeker and her colleagues recently received two awards and their paper, “Building Research Integrity and Capacity (BRIC): An Educational Initiative to Increase Research Literacy among Community Health Workers and Promotores,” was published in the Journal of Microbiology and Biology Education.
In the pilot study, Holub and Nebeker are looking at health disparities specific to Native Hawaiians and Pacific Islanders, who previously had been aggregated with the Asian community. “There’s been a huge push to focus on individual communities to really get at the root of any health problem or concern so we can intervene appropriately,” said Holub. “A large part of this study is considering culture and how we can integrate culturally inspired activities so that people who are already dancing or paddling can see these as ways to be healthy and active.”
Recruitment for the study is in progress. Thirty participants will be in the pilot, and will begin with physical activity classes, followed by leadership training. “Our partnership with Rawmana Fitness and Dr. Nebeker’s expertise around research ethics really helped us train our community partner and our community health workers,” Holub said.
Nebeker said the training shows community health workers (also called Promotores de Salud in the Latino community or Community Health Navigators in the Pacific Islander community) about the bigger picture, how their tasks in the studies fit into that picture, and how they are part of the research team.
There is an urgency to improve Pacific Islander health in San Diego and beyond. Increasing physical activity is a major step toward that goal. “The first and last activity in the pilot is a six-person outrigger canoe paddling exercise. It shows two things – the strength needed to paddle and the importance of working together. At the end, the participants should be stronger and have a better sense of teamwork,” Holub said. “In the canoe, if one falls, you all fall. If one stops paddling, you all slow down.” Other activities include learning basic Hula, Tahitian, and other traditional dances.
Health measurements will be done in the community itself, at Rawmana, and meaningful data will be reported back to the individuals. “The pilot project supported by CTRI is really leveraging community resources,” Holub said.
One of those resources is the Rawmana Fitness Center, which was established by Veimau and his family with a philosophy of intermingling fitness and culture. Asked how he would motivate the study’s participants, Veimau offered, “For change to occur, you must have a true understanding of your self-integrity, which becomes the bridge to the person who you are now and the discovery of yourself.”
BRIC Awards and Journal Publication
Camille Nebeker and her colleagues recently received two awards for the BRIC program: a 2015 Health Improvement Institute Award for Best Practices and for Innovation; and a $1,000 award from the UC San Diego Health Office of Government and Community Affairs to support a one-day professional development conference for local community health workers and promotores. In March, their paper, “Building Research Integrity and Capacity (BRIC): An Educational Initiative to Increase Research Literacy among Community Health Workers and Promotores,” was published in the Journal of Microbiology and Biology Education’s special issue on Citizen Science.
Read more about BRIC in the UC San Diego Health Sciences news release by Michelle Brubaker, “Educating Community Research Facilitators Helps Protect Integrity of Study Results.”
Formative research for this pilot was funded by the American Cancer Society, Postdoctoral Fellowship awarded to Christina K. Holub in Cancer Health Disparities Research, Grant #: PF-13-017-01-CPPB.
The BRIC study was supported, in part, by the National Institutes of Health (T15, JL072440) and the Office of Research Integrity (HHSP233200400813P and ORIIR130005-01-00).