摘要：We evaluated a community-based 12-week healthy lifestyle program in Moloka‘i, HI, called Ke ‘Ano Ola, which was developed to decrease chronic disease risk through health education emphasizing weight loss, exercise, and risk factor reduction. Program leaders' strong commitment and positive role modeling, along with social and group support and community involvement, were key elements. A pre–post evaluation of weight, blood pressure, total cholesterol, and blood sugar showed significant improvements for weight (mean change [Δ] = −7.4 lbs; P < .001), systolic blood pressure (Δ = –3.8 mm Hg; P = .027), diastolic blood pressure (Δ = –4.6 mm Hg; P < .001), and total cholesterol (Δ = –9.7 mg/dL; P < .001). Attrition was low, with 89% of participants attending all 12 sessions. Our findings show that lifestyle improvements in a predominantly Native Hawaiian community are achievable in a support group setting. IN 2008, AN ESTIMATED 72.8% of the residents of Moloka‘i, HI, were overweight (body mass index [BMI; defined as mass in kilograms divided by height in meters squared] = 25–29 kg/m2) or obese (BMI ≥ 30 kg/m2); only an estimated 57.4% of Honolulu residents were similarly overweight. Native Hawaiians in the state were more than twice as likely as Whites to be obese (44.1% versus 21.3%, respectively). 1 The prevalence of obesity among Hawaiians on Moloka‘i, a predominantly Hawaiian community, is in stark contrast to the entire state of Hawai‘i, which was ranked the second healthiest state in the nation in 2008. 2 Hawaiians, especially those living on Moloka‘i, continue to experience significant health disparities and therefore need health interventions that are community driven and culturally appropriate. KEY FINDINGS Effects of the Ke 'Ano Ola intervention after 3 months: ▪Improved diastolic blood pressure, ▪Improved systolic blood pressure, ▪Decreased body weight, ▪Improved total cholesterol level, ▪Improved low-density lipoprotein level, ▪Improved high-density lipoprotein level, and ▪High participant satisfaction. Several commercial weight-loss programs have come to Moloka‘i, with limited long-term success. In 2008, community members requested that Na Pu‘uwai, the island's Native Hawaiian health care system, whose mission is to improve the overall health and wellness of Hawaiians living on Moloka‘i, offer a weight-loss program that could be community driven and sustained long term. This request was made to the Na Pu‘uwai staff by persons participating in health-screening events or receiving regular monitoring of blood glucose and hypertension. A team of Na Pu‘uwai staff and off-island consultants—an epidemiologist, a registered dietician, a lifestyle interventionist, a medical director, a psychologist, 2 registered nurses, and 5 community health workers—developed a lifestyle intervention program. After considering the requests of community members and evaluating past lifestyle interventions, the team created Ke ‘Ano Ola (KAO). This name, which means healthy lifestyle, was suggested by a Moloka‘i Hawaiian-language expert and reflects the healthy lifestyle and community participation nature of the program. Three important components of successful lifestyle interventions were incorporated into KAO: social support, group support, and community involvement. A previous study evaluated mediators of lifestyle behavior change in Native Hawaiians and found that social support was a key factor in moving participants from the preaction stage of change to the action–maintenance stage for improvements in dietary fat intake and exercise. 3 Another study looked at group support as a component of weight-loss and maintenance programs and found that recruiting and treating teams of 3 friends with a strong social support intervention decreased the number of dropouts and markedly increased the percentage of participants who maintained their weight loss over the 6-month follow up period. 4 It has been shown that community involvement is an important aspect of successful programs tailored for Native Hawaiians. This is exemplified by the Partnership for Improving Lifestyle Interventions project. 5 The objective of KAO was to decrease risk factors for chronic disease—primarily obesity, hypertension, hypercholesterolemia, and diabetes—through nutrition, physical activity, and specific chronic disease prevention education in a support group setting. Open in a separate window Ke ‘Ano Ola participants and staff assistants preparing a healthy meal.
