Introduction
Native Hawaiians/Pacific Islanders (NHPIs) face disproportionate burdens of diabetes and cardiometabolic disease. This study assessed the feasibility and effectiveness of the PILI Pasifika Program (PPP), a culturally grounded, community health worker (CHW)-led lifestyle intervention that targets social determinants of health (SDoH) to improve cardiometabolic risk factors among NHPI adults.
Study Design
A parallel-group randomized controlled trial with an education material-only waitlist control was conducted. Implementation feasibility was assessed through interviews with CHWs, and participant acceptability via survey. SETTING/PARTICIPANTS: Across four US states and two US-affiliated Pacific Islands, 24 CHWs recruited and delivered the PPP to 242 NHPI adults with ≥1 cardiometabolic risk factor (130 intervention, 112 control), and assessed cardiometabolic, behavioral, and SDoH outcomes.
Intervention
PPP consisted of 12 weekly sessions, adapted from the Diabetes Prevention Program and augmented with SDoH-focused activities.
Main Outcome Measures
Weight, HbA1c, blood pressure, HDL, LDL, and total cholesterol. Data collected from 2024 to 2025, analyzed in 2025.
Results
PPP participants compared with controls showed significant reductions in weight (-2.8 vs +0.5 kg), HbA1c (-0.8% vs +0.1%), systolic (-5.7 vs +2.6 mmHg) and diastolic (-3.4 vs +1.3 mmHg) blood pressure, LDL (-4.7 vs +7.6 mg/dL), and total cholesterol (-9.7 vs +9.4 mg/dL). Intervention participants also showed significant improvements in fruit/vegetable intake, physical activity, food literacy, social support, housing stability, and overall well-being. CHWs and participants found the PPP highly feasible, culturally relevant, and adaptable.
Conclusions
The PPP, delivered by culturally competent CHWs, improved cardiometabolic, behavioral, and SDoH outcomes among NHPI adults and shows promise for scalable, sustainable implementation across diverse NHPI communities.
Trial Registration
ClinicalTrials.gov (NCT06471595).