'Ai Pono Cooking Demonstrations

The PILI 'Āina Project

Native Hawaiians' traditional lifestyles and diets ensured the mutual health and well-being of the land and its inhabitants, which stand in stark contrast to the disproportionately high prevalence of diet-related, cardiometabolic diseases they experience today. In this project, the investigators will adapt and test an evidence-based multilevel intervention entitled PILI 'Āina to improve the self-management of prevalent cardiometabolic diseases and reduce risk factors for developing new diet-related illnesses and implement and evaluate the impact and sustainability of community-wide cooking demonstrations. The objectives of this project are to optimize the effectiveness and sustainability of PILI 'Āina, improve diet quality, cardiometabolic markers, promote traditional Native Hawaiian diets, and improve social cohesion.

Study Overview

• Status: Recruiting
• Conditions: Hypertension; Dyslipidemias; Type 2 Diabetes; Overweight and Obesity
• Intervention / Treatment: Other: 'Ai Pono

Detailed Description

In Years 1 - 5, the investigators will hold quarterly cooking demonstrations and cultural lessons for a total of 36 events. The lessons will be aimed at improving family and community eating environments of participants and social cohesion of these communities. Attendance at each lesson will be limited to 30 individuals. Attendees will register via REDCap using their names and email addresses. There is no limit to how many lessons an individual can attend, but after the first lesson the investigators reserve 15 of the 30 spots for people who have not attended previously, as identified by their registration information. At each quarterly event, the investigators survey participants to assess their reaction to the lesson, their vegetable and fruit intake, self-efficacy for healthy diet, and perceptions of community cohesion. Surveys will take ~5-10 minutes to complete. Additionally, the investigators will survey random samples of homestead households (n = 20 per homestead, total n = 140 per year) in Projects Years 1 - 5. Total sample for this activity is 700. Each sample will be selected independent of previous samples, and it is possible the same households will be sampled multiple times.

• Study Type: Interventional
• Enrollment (Estimated): 1780
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Claire Ing, DrPH; Phone Number: 8086921042; Email: clairemt@hawaii.edu
• Study Contact Backup: Name: Ki'i Aweau

Study Locations

• United States
  • Hawaii
    • Honolulu, Hawaii, United States, 96813
      • Recruiting
      • Kula no na Poe Hawaii
      • Contact: Meghan Kenney; Phone Number: 8085208997; Email: meghan@kula-papakolea.org
    • Kapolei, Hawaii, United States, 96707
      • Recruiting
      • Kapolei Community Development Coalition
      • Contact: Chantal Keliihoomalu; Email: executivedirector@kapoleiheritage.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 18+ (looking for older adults)
• Native Hawaiian resident in a participating homestead
• Overweight or obese (BMI ≥ 25 kg/m^2)
• Prior diagnosis of type 2 diabetes or pre-diabetes, hypertension, and/or dyslipidemia (LDL cholesterol ≥ 130 mg/dL)
• Capable of 150 minutes of moderate physical activity (e.g., brisk walking) per week
• Willing and able to participate in all aspects of the individual and household-level intervention
• Fluent in written and spoken English

Exclusion Criteria:

• No children
• Pregnancy
• Serious illness such as cancer or chronic pain that may contraindicate full participation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: Aim 3: Community Level Intervention; Aim 3 is community-driven, supports the overall goal of the PILI 'Āina project, allows all members of the community to benefit, and is strongly promoted within the community. The investigators will design and implement 'Ai Pono, a community-level component that can operate in tandem with PILI 'Āina. This component will not be tested in the group-randomized trial. Instead, all 7 communities will implement 'Ai Pono for the full study period.

Other: 'Ai Pono; "Hands-on Cooking and Cultural Lessons" These lessons will be widely advertised. Each 2-hour presentation will involve hands-on cooking demonstrations and tastings, accompanied by lessons on the cultural significance of featured food items. Demonstrations will link the consumption of vegetables (e.g., sweet potato, breadfruit, kalo) to Native Hawaiian (NH) history and traditional beliefs to help participants rediscover their heritage through the meals they prepare.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nutrition Environment	The perceived 9-item nutrition environment will be measured by the Gustafson Perceived Nutrition Environment Measures questionnaire, which examines perceived access and availability of healthy foods within ~1 mile of the participant's home, and the availability and affordability of produce in the participant's primary food store. The responses and scores vary depending on the question including 0- disagree, 1-agree, and 0-not important, 1-slightly important, 2-moderately important, 3- important, 4-very important. Higher scores indicate higher perceived access and availability of food.	Baseline, 1-year, 2-year, 3-year, 4-year
Family Environment	Three subscales, Cohesion, Expressiveness, and Conflict, assess the degree of commitment and support family members provide for one another, the extent to which family members are encouraged to express their feelings directly, and the amount of openly expressed anger and conflict among family members.	Baseline, 1-year, 2-year, 3-year, 4-year
Social Cohesionn	4-item subscale of the neighborhood level stressors which asks about perceived shared values and trust.	Baseline, 1-year, 2-year, 3-year, 4-year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diet Self-Efficacy	The 11-item Diet Self Efficacy Scale will measure self-efficacy in avoiding tempting high caloric food and managing social and internal cues and negative emotions. The responses and scores range from 1-strongly disagree, 2-somewhat disagree, 3-neutral, 4-somewhat agree, and 5-strongly agree. Higher scores indicate greater self-efficacy with diet.	Baseline, 1-year, 2-year, 3-year, 4-year
Food Literacy	Food literacy, defined as the ability to make healthy food choices in different settings and situations, will be assessed by the 11-item self-perceived food literacy scale, which encompasses knowledge, skills, and behaviors pertinent to planning, selecting, preparing, and eating healthy food. The responses and scores range from 1-not at all/never, 2-disagree, 3-slightly disagree, 4- slightly agree, 5-yes/always. Higher scores indicate greater food literacy.	Baseline, 1-year, 2-year, 3-year, 4-year
Social Support	Social support for a healthy diet will be measured as the perceived support that people who make dietary changes receive from family and friends. An 11-item questionnaire on social support will be used to ask participants' perceived level of support from friends and family regarding diet choices. The responses and scores range from 1-strongly disagree, 2-somewhat disagree, 3-neutral, 4-somewhat agree, and 5-strongly agree. Higher scores indicate greater social support.	Baseline, 1-year, 2-year, 3-year, 4-year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cultural Identity	Cultural factors will be measured by the 4-item Cultural Identity Scale that will assess the degree of identification with NH cultural heritage. The responses and scores range from 0-not at all knowledgeable, 1- somewhat not knowledgeable, 2-neutral or no response, 3-somewhat knowledgeable, and 4-very knowledgeable. Higher scores indicate greater cultural identity.	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Date of Birth	Date of birth: Month; Day; Year	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Biological Sex	Biological Sex: Female; Male	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Marital status	Marital Status: Never married; Currently married; Divorced or separated; Widow/widower; Domestic partnership/other	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Employment	Employment: Full time; Part-time; Unemployed; Self-employed; Retired; Unable to work/other; Household caretaker	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Education	Education: Less than high school; High school diploma/General Education Diploma (GED); Some college/technical training; College degree; Graduate/professional degree	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Ethnic ancestry	Ethnic Ancestry: Caucasian; Chinese; Filipino; Hawaiian; Latino; Japanese; Korean; Marshallese; Micronesian (specify); Native American; Portuguese; Samoan; Other (specify)	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Household income	Household Income: Under $49,999; $50,000-$74,999; $75,000-$99,999; $100,000-$124,999; Over $125,000 Household income will be classified according to the US Census Bureau's poverty threshold by using a dichotomous variable. Participation in public assistance programs (e.g., Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program) will also be recorded.	Baseline, 1-year, 2-year, 3-year, 4-year
Demographic Data- Household Composition	Household Composition: 1. Who lives in the participant's house full-time? (50% or more time spent in-house); Parents; Children; Grandparents/great-grandparents; Other family membersa. Of those people, what are their ages and genders?; Male: 17 years and under, 18-29 yrs, 30-39 yrs, 40-39 yrs, 50-59 yrs, 60+ yrs; Female: 17 years and under, 18-29 yrs, 30-39 yrs, 40-39 yrs, 50-59 yrs, 60+ yrs; Number of other/non-binary: 17 years and under, 18-29 yrs, 30-39 yrs, 40-39 yrs, 50-59 yrs, 60+ yrs	Baseline, 1-year, 2-year, 3-year, 4-year

Collaborators and Investigators

• Sponsor: University of Hawaii
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health (NIH); American Heart Association
• Investigators: Principal Investigator: Claire Ing, DrPH, Principal Investigator; Study Chair: Kulani DeSimone, B.S., Graduate Assistant

Study record dates

Study Major Dates

• Study Start (Actual): February 12, 2025
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): August 1, 2028

Study Registration Dates

• First Submitted: June 7, 2024
• First Submitted That Met QC Criteria: July 24, 2024
• First Posted (Actual): July 30, 2024

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 2, 2026
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight; Glucose Metabolism Disorders; Diabetes Mellitus; Lipid Metabolism Disorders; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Obesity; Hypertension; Diabetes Mellitus, Type 2; Dyslipidemias
• Other Study ID Numbers: PILI 'Āina 3; R01HL168858 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No