Community-Based Participatory Research Integrates Behavioral and Biological Research to Achieve Health Equity for Native Hawaiians

Claire K M Townsend, Adrienne Dillard, Kelsea K Hosoda, Gregory G Maskarinec, Alika K Maunakea, Sheryl R Yoshimura, Claire Hughes, Donna-Marie Palakiko, Bridget Puni Kehauoha, Joseph Keawe'aimoku Kaholokula, Claire K M Townsend, Adrienne Dillard, Kelsea K Hosoda, Gregory G Maskarinec, Alika K Maunakea, Sheryl R Yoshimura, Claire Hughes, Donna-Marie Palakiko, Bridget Puni Kehauoha, Joseph Keawe'aimoku Kaholokula

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.

Trial registration: ClinicalTrials.gov NCT02144909.

Keywords: Native Hawaiians; community-based participatory research; diabetes self-management; epigenomics.

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