title: Community-Based Participatory Research Integrates Behavioral and Biological Research to Achieve Health Equity for Native Hawaiians.
abstract: Native Hawaiians bear a disproportionate burden of type-2 diabetes and related complications compared to all other groups in Hawai'i (e.g., Whites, Japanese, Korean). Distrust in these communities is a significant barrier to participation in epigenetic research studies seeking to better understand disease processes. The purpose of this paper is to describe the community-based participatory research (CBPR) approach and research process we employed to integrate behavior and biological sciences with community health priorities. A CBPR approach was used to test a 3-month evidence-based, diabetes self-management intervention (N = 65). To investigate the molecular mechanisms linking inflammation with glucose homeostasis, a subset of participants (n = 16) provided peripheral blood mononuclear cells. Community and academic researchers collaborated on research design, assessment protocols, and participant recruitment, prioritizing participants' convenience and education and strictly limiting the use of the data collected. Preliminary results indicate significant changes in DNA methylation at gene regions associated with inflammation and diabetes signaling pathways and significant improvements in hemoglobin A1c, self-care activities, and diabetes distress and understanding. This study integrates community, behavioral, and epigenomic expertise to better understand the outcomes of a diabetes self-management intervention. Key lessons learned suggest the studies requiring biospecimen collection in indigenous populations require community trust of the researchers, mutual benefits for the community and researchers, and for the researchers to prioritize the community's needs. CBPR may be an important tool in providing communities the voice and protections to participate in studies requiring biospecimens.
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA. clairemt@hawaii.edu.
authors.forename: Claire K M
authors.initials: CK
authors.lastname: Townsend
authors.affiliation: Kula no na Po'e Hawai'i, P.O. Box 2368, Honolulu, HI 96823, USA. kula.papakolea@gmail.com.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Dillard
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA. clairemt@hawaii.edu.
authors.forename: Kelsea K
authors.initials: KK
authors.lastname: Hosoda
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA. khosoda@hawaii.edu.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Maskarinec
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA. gregorym@hawaii.edu.
authors.forename: Alika K
authors.initials: AK
authors.lastname: Maunakea
authors.affiliation: Kōkua Kalihi Valley Comprehensive Family Services, 2239 N. School Street, Honolulu, HI 96819, USA. sryoshimura@gmail.com.
authors.forename: Sheryl R
authors.initials: SR
authors.lastname: Yoshimura
authors.affiliation: Hawai'i Maoli, Association of Hawaiian Civic Clubs, P.O. Box 3866 Honolulu, HI 96812, USA. hughes1926@aol.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Hughes
authors.affiliation: Ke Ola Mamo, Dillingham Plaza, 1505 Dillingham Blvd #205, Honolulu, HI 96817, USA. dpalakiko@keolamamo.org.
authors.forename: Donna-Marie
authors.initials: DM
authors.lastname: Palakiko
authors.affiliation: Kula no na Po'e Hawai'i, P.O. Box 2368, Honolulu, HI 96823, USA. punikekauoha@gmail.com.
authors.forename: Bridget Puni
authors.initials: BP
authors.lastname: Kehauoha
authors.affiliation: Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, MEB 307L, Honolulu, HI 96813, USA. amaunake@hawaii.edu.
authors.forename: Joseph Keawe'aimoku
authors.initials: JK
authors.lastname: Kaholokula
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data; D035843:Biomedical Research / Q000379:methods*; D055812:Community-Based Participatory Research / Q000379:methods*; D003159:Community-Institutional Relations; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D000069576:Health Equity; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D018579:Patient Selection; D011634:Public Health; D012107:Research Design; D012648:Self Care / Q000379:methods*; D044465:White People / Q000706:statistics & numerical data
keywords: Native Hawaiians; community-based participatory research; diabetes self-management; epigenomics