group facilitators
No Ke Ola Pono o Nā Kāne group discussion facilitators.

In Hawaiʻi, Native Hawaiian men (kāne) have the highest death rate from colon cancer among all ethnic groups. While screening can prevent 90 percent of these cancers, data shows that nearly 60 percent of kāne over age 50 have never been screened. Prior research has demonstrated that community-based social networks may help kāne adopt healthy behaviors such as cancer screening, but, few studies have activated an approach using Native Hawaiian traditional practices, such as one conducted by the University of Hawaiʻi Cancer Center.

The study results of No Ke Ola Pono o Nā Kāne (for the good health of men) project, conducted statewide in Hawaiʻi to promote health improvement in Native Hawaiian kāne through culturally grounded approaches, was published in the American Journal of Men’s Health.

Hale mua and hui kūkākūkā

native hawaiian tools used in sessions
Examples of traditional use of cordage to guide hui kūkākūkā sessions.

The study perpetuated Native Hawaiian traditional practices of hale mua (men’s house) and community hui kūkākūkā (discussion groups) to promote healthy behaviors among kāne. The study also emphasized colon cancer prevention strategies such as using the fecal immunochemical test (FIT). Native Hawaiian kāne volunteers conducted peer-led interventions using the program’s educational components of standardized materials and four modules to guide the sessions. The module’s topics covered lung, colorectal and oronasopharyngeal cancers.

In partnership with Ke Ola Mamo, Oʻahu’s Native Hawaiian Health Care System, 378 kāne were recruited into the study from 2014 to 2018, and 232 participated in the colorectal discussion groups, of which 64 percent (149) were over age 50. Of the 149 colorectal discussion group participants, 31 percent had not discussed colon health or screening with their physicians, but 92 percent improved their knowledge about colon health from the sessions. In addition, 76 percent agreed to complete a FIT. Session evaluations also indicated that more than 91 percent of kāne liked the hale mua approach and benefited from talking with other kāne about their health.

“Early and regular screening for precancerous colon lesions can prevent nearly 90 percent of colon cancers,” said Kevin Cassel, UH Cancer Center assistant researcher and principal investigator. “Our study results show that introducing FIT to kāne through community hui kūkākūkā may help fight the disease among kāne.”

The major discussion themes at the peer-led interventions included healthy traditional Hawaiian lifestyle and the role of kāne in the Hawaiian family. In addition, discussions focused on knowledge, attitudes and behaviors surrounding each session’s health promotion topics. Participants also noted appreciation for having a Native Hawaiian kauka (physician) present at every session.

The study highlights that in Hawaiʻi, Native Hawaiians bear disproportionately higher rates of chronic illnesses including diabetes, cardiovascular diseases, obesity and cancer compared to the overall state population. In addition, many Native Hawaiians live in rural communities where health care and recreation services are meager, distant or non-existent.

“The culturally-based traditions of the hale mua and community hui kūkākūkā can be the foundation to address health disparities among kāne. It is important to continue future studies to explore these culturally-based approaches, and extend group discussion topics addressing health issues relevant to Native Hawaiian men,” said Nathan Wong, study kauka and UH Cancer Center Native Hawaiian Community Advisory Board member.

—By Nana Ohkawa

group of people join hands in prayer
The No Ke Ola Pono o Nā Kāne project stakeholders hold a pule at their annual report to the community.