Abstract IA46: Using CBPR to reduce obesity disparities for Hawaiians: Findings from an RCT
Authors: Braun Kathryn 
Published: October 2015

Background: Surveillance data suggest that 75% of Native Hawaiians and Pacific Islanders (NHPI) in Hawai‘i are overweight or obese (BMI ≥ 25), which increases their risk of chronic disease, including cancer. Worksites are an ideal venue for health promotion, as individuals spend 40 hours or more each week at work. To tackle this problem, community members joined with university-based researchers to develop a weight-loss intervention. Community PIs were hired at five sites (including a Hawaiian homestead council, an association of Hawaiian civic clubs, and clinics serving Hawaiian communities) to adapt the Diabetes Prevention Program's Lifestyle Intervention (DPPLI) to incorporate Hawaiian values of peer support and responsibility and neighborhood context. Initially implemented in community settings, this intervention was further adapted with community PIs from seven Hawaiian-serving agencies for implementation in the worksite.

Intervention: The final, 12-month, worksite intervention was called PILI@Work. The name PILI is an acronym for Partnerships to Improve Lifestyle Interventions, and it is also a Hawaiian word that means close relationship, relative, to be with, adhere to, touch and join. The intervention includes a 3-month weight-loss phase, followed by a 9-month weight-loss-maintenance phase. The weight-loss phase includes 8 lessons delivered to small groups. These lessons provide information about and practical tips related to diet and exercise, and peer-educators use motivational interviewing, action planning, and peer support techniques to promote behavior change. Most peer-educators are Native Hawaiian of Pacific Islanders, recruited from the worksite. The weight-loss-maintenance phase includes 11 lessons.

Study Design: PILI@Work was tested with a cluster randomized control design, with randomization of worksites into experimental and control conditions. All worksites participated in baseline data collection and received the 3-month, weight-loss portion of the intervention in a small group face to face (FTF) format. After 3-month data were collected, worksites were randomized to receive the weight-loss-maintenance phase either in a small group, FTF format or in DVD format. Those in the DVD group were able to view the DVDs in a small group format or according to their own convenience. The timing of the FTF and DVD lessons was the same across groups.

Agencies were recruited if they provided health and/or social services to Native Hawaiians and/or Pacific Islanders, as these worksites tend to employ large percentages of NHPI. All employees, regardless of ethnicity, were eligible if they were overweight or obese (BMI ≥ 25, or ≥ 23 for Filipino and Asian Americans). Collected at baseline were ethnicity, height, age, sex, education, and marital status. At baseline, 3 months, and 12-months, data were collected on weight (lbs), blood pressure (mmHg), physical functioning (measured by a 6-min. walk test, 6MWT), exercise intensity, fat intake, eating self-efficacy, exercise self-efficacy, community support, family support, and external locus of weight control. Paired t-tests and multivariate regression were used to test effects.

Results: Recruitment goals were easily met, and about 75% of participants have been retained. To date, 207 overweight/obese employees (62% NHPP) from 14 organizations completed the 3-month, weigh-loss phase. These worksites, comprising 20 groups, 17 of which were randomized separately to either DVD (9 groups with 99 employees total) or FTF arm (8 worksites with 108 total) for the 9-month weight-loss maintenance phase. Baseline characteristics were: mean BMI=34.1 ± 14.5, mean weight=87.2kg ± 21.7, mean age=46.0 ± 11.5, 87% female, and 63% college graduates. om baseline to 3 month follow up, significant (p &lt;.05) improvements in weight [-1.2 ± 2.7], systolic [-2.8g ± 12.6] and diastolic [-2.1 ± 8.1] blood pressure, 6MWT [77.7ft ± 155.5],exercise level, and fat intake were found, with 23% of participants losing ≥3% of their initial body weight.

At 12-month follow up, there were significant improvements in 6MWT [32.1 ± 101.9] and exercise intensity, with 35% of participants losing ≥ 3% of their initial body weight. Of those who lost weight at 3 month follow-up, 93% of FTF and 82% of DVD participants regained &lt; 3% of 3-month follow up weight. No significant difference [c2 (1,80) = 2.11, p = .15) was seen between the two arms, indicating that both the DVD and FTF versions of the PILI@Work maintenance phase are comparable in their effectiveness in achieving and maintaining modest weight loss.

Implications: The 12-month intervention appears to be effective with either an in-person or DVD-delivered maintenance phase. As the DVD approach requires fewer resources, this may be a feasible, flexible, and cost-effective means of providing a lifestyle intervention at worksites.

Citation Format: Kathryn Braun. Using CBPR to reduce obesity disparities for Hawaiians: Findings from an RCT. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr IA46.