# Part 1: A Systematic Review to Describe Existing Cultural Adaptations in Lifestyle, Nutrition, and Physical Activity Programs for Native Hawaiian, CHamoru, and Filipino Populations

## TL;DR

This study reviews lifestyle programs adapted for Native Hawaiian, CHamoru, and Filipino populations to address obesity and related health issues.

## Contribution

The study systematically reviews cultural adaptations in health programs for underrepresented Pacific Islander and Filipino populations.

## Key findings

- 29 articles described culturally adapted interventions for Native Hawaiian, CHamoru, and Filipino populations.
- Most interventions combined nutrition and physical activity and targeted pre-diabetes, hypertension, and obesity.
- Fewer interventions included CHamoru populations, suggesting a need for more research in this area.

## Abstract

This research aims to describe existing evidence on the availability of culturally adapted lifestyle, nutrition, and physical activity programs among Native Hawaiian, CHamoru, and Filipino populations who are affected by obesity at rates higher than the general US population, contributing to poorer health outcomes. Addressing this disparity requires programs that are culturally adapted and grounded for these specific populations. A comprehensive description of the availability of lifestyle interventions for Native Hawaiians, Pacific Islanders, and Filipinos is missing in the literature. A systematic literature review was performed in July 2025 to gather articles that included lifestyle (nutrition and/or physical activity) interventions addressing obesity and/or related chronic diseases and that utilized one or more cultural adaptations for Native Hawaiian, CHamoru, and/or Filipino populations. Data were extracted, and methodological quality, social ecological model (SEM) level, and risk for bias was assessed. Twenty-nine articles met inclusion criteria. Interventions addressed pre-diabetes (n = 7), hypertension (n = 7), and/or obesity (n = 5) and included combined nutrition and physical activity (n = 16). Sixteen articles included interventions culturally adapted for Filipino populations only, 7 for Native Hawaiians only, 6 for both Native Hawaiians and Filipinos, and 2 included CHamorus. The most common combination of approaches were interventions that incorporated individual, interpersonal, and community SEM levels (n = 17). Intervention components were reflective of culturally relevant physical activities (n = 16) and nutrition (n = 11). Based on this research, there is a need for additional research to include CHamoru communities and interventions to be tested in geographic locations where these populations have migrated.