Abstract
INTRODUCTION: Native Hawaiians/Pacific Islanders face disproportionate burdens of cardiometabolic diseases. This study assessed the feasibility and effectiveness of the PILI Pasifika Program, a culturally grounded, community health worker-led lifestyle intervention that targets social determinants of health to improve cardiometabolic risk factors among Native Hawaiians/Pacific Islander adults. STUDY DESIGN: A parallel-group RCT with an education material-only waitlist control was conducted. Implementation feasibility was assessed through interviews with community health workers, and participant acceptability was assessed through survey. SETTING/PARTICIPANTS: Across four U.S. states and 2 U.S.-affiliated Pacific Islands, 24 community health workers recruited and delivered the PILI Pasifika Program to 242 Native Hawaiians/Pacific Islander adults with ≥1 cardiometabolic risk factor (130 intervention, 112 control) and assessed cardiometabolic, behavioral, and social determinants of health outcomes. INTERVENTION: PILI Pasifika Program consisted of 12 weekly sessions, adapted from the Diabetes Prevention Program and augmented with social determinants of health-focused activities. MAIN OUTCOME MEASURES: Weight, HbA1c, blood pressure, high-density lipoprotein, low-density lipoprotein, and total cholesterol were the outcome measures. Data were collected from 2024 to 2025 and analyzed in 2025. RESULTS: PILI Pasifika Program 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, low-density lipoprotein (-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. Community health workers and participants found the PILI Pasifika Program highly feasible, culturally relevant, and adaptable. CONCLUSIONS: The PILI Pasifika Program, delivered by culturally competent community health workers, improved cardiometabolic, behavioral, and social determinants of health outcomes among Native Hawaiians/Pacific Islander adults and shows promise for scalable, sustainable implementation across diverse Native Hawaiians/Pacific Islander communities. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov (NCT06471595).