BackgroundAmong indigenous populations in remote locations who are at increased risk for chronic diseases such as diabetes, telemedicine has the potential to improve access to health care services and thus may reduce adverse health outcomes. Yet few studies are available on how best to use telemedicine technology in reducing ethnic and racial health care disparities.ObjectiveWe examined perspectives of patients and providers in 2 indigenous populations in Alaska and Hawai'i about the use of telemedicine in primary care chronic disease management.DesignSix focus groups with patients and providers at 2 sites (3 in Alaska and 3 in Hawai'i).ResultsThree broad themes were common to both sites: (a) benefits and barriers of using telemedicine; (b) building patient–provider relationships; and (c) elements of an acceptable telemedicine primary care encounter. Two key elements were endorsed by both patients and providers as important for an effective telemedicine encounter: (a) the initial patient–provider interaction should be face-to-face; and (b) patients must see the same provider on follow-up visits.ConclusionThe use of telemedicine in chronic disease management has potential to improve patient care in remote indigenous populations and may supplement patient–provider relationships.

Context Obesity, diabetes, and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural, and socioeconomic realities is a public health priority. Objective To describe cultural adaptation and cultural grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai‘i: PILI ‘Ohana and KāHOLO Projects. Methods A literature review of 14 studies from these two projects were done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the “ground up” to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioral outcomes of both types of interventions. Results Both cultural adapted and cultural grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes, and hypertension. Conclusion Several recommendations are provided based on the lessons learned from the PILI ‘Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental, and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.

Objectives Pacific Islanders are disproportionately burdened by poorer perinatal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care. The aim of this study is to examine Marshallese mothers' beliefs, perceptions, and experiences of prenatal care and to identify potential barriers. Methods Three focus groups were conducted with Marshallese mothers, who were 18 years or older, and living in Arkansas. Focus groups focused on mothers' beliefs, perceptions, and experiences of prenatal care. A thematic qualitative analysis was conducted to identify salient themes within the data. Results The results demonstrated that negotiating health insurance, transportation, and language barriers were all major structural barriers that constrain prenatal care. The social-cultural barriers that emerged included a lack of understanding of the importance of seeking early and consistent prenatal care, as well as how to navigate the healthcare process. The more complicated challenges that emerged were the feelings of shame and embarrassment due to the perception of their age or being unmarried during pregnancy not being acceptable in American culture. Furthermore, the participants described perceived discrimination from prenatal care providers. Lastly, the participants described fear as a barrier to seeking out prenatal care. Conclusions for Practice This study identified both structural and socio-cultural barriers that can be incorporated into suggestions for policy makers to aid in alleviating maternal health disparities among Pacific Islander women. Further research is needed to address the Marshallese mothers' perceived discrimination from maternal health care providers.

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Background Dissemination is a principle within community-based participatory research (CBPR); however, published research focuses on the dissemination of findings from CBPR projects but less on dissemination of interventions developed through CBPR approaches. To disseminate an evidence-based lifestyle intervention tailored for Native Hawaiians and Pacific Islanders, the PILI 'Ohana Project (POP), an 11-year CBPR initiative, developed an innovative dissemination model. Objectives The Community-to-Community Mentoring (CCM) model described in this paper extends the application of CBPR values and principles used in intervention development to intervention dissemination. Methods The CCM model combines a CBPR orientation with the Diffusion of Innovation Theory, the Social Cognitive Theory, and key concepts from community organizing and community building to address the multilevel factors that influence uptake of an evidence-based intervention. Grounding the model in CBPR principles provides benefits for intervention dissemination and integrates a focus on community benefits and capacity building. Conclusions By establishing co-equal, mutually beneficial relationships at the core of the CCM model, opportunities are created for building critical consciousness, community capacity, and social capital. More research is needed to determine the effectiveness of this model of intervention dissemination which may enhance diffusion of CBPR interventions and empower communities in the process.