The Impact of a Community Health Worker-Led Lifestyle-Social Determinants Program on Pacific Islander Cardiometabolic Health.

Abstract

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. 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. 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. PILI Pasifika Program consisted of 12 weekly sessions, adapted from the Diabetes Prevention Program and augmented with social determinants of health-focused activities. 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. 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. 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. This study is registered at ClinicalTrials.gov (NCT06471595).