# The Kaiona Framework: Centering Hawaiian and Pasifika Community in Defining, Measuring, and Promoting Health and Well-Being

## TL;DR

The paper introduces the Kaiona Framework, a community-led approach to health and well-being centered on Hawaiian and Pasifika traditions to address youth mental health and chronic conditions.

## Contribution

The novel contribution is a culturally grounded framework co-created by the community to redefine health metrics and interventions.

## Key findings

- The Kaiona Framework emphasizes four values: mauli ola, waiwai, pilina, and ea.
- Community-driven methodologies were developed to assess health status and program impact.
- The framework aims to improve youth health through culturally aligned partnerships and referral systems.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This work represents a community response to youth mental health and chronic health conditions, critical issues to the health systems and populations of Hawaiʻi, the USA, and the globe.This work aims to address the structural problems that are at the root of health disparities faced by our Indigenous community.

This work represents a community response to youth mental health and chronic health conditions, critical issues to the health systems and populations of Hawaiʻi, the USA, and the globe.

This work aims to address the structural problems that are at the root of health disparities faced by our Indigenous community.

Public health significance—Why is this work of significance to public health?
Under the direction of community leaders and rooted in place-based traditions and culture, this work details the effort of a Hawaiian community to make clear its own priorities and values around health and well-being, directly in response to the outside systems and metrics that have failed to uplift the gifts and abundance of this place.The Kaiona Framework detailed in this work serves as the foundation for subsequent efforts of our collective: (a) creating novel quantitative and qualitative methodologies to assess health status and program impact based on local traditions and values; (b) formalizing and assessing a referral system for pediatric patients in our local community health center to culture-based programming to address mental health and chronic health needs; and (c) catalyzing partnerships across the healthcare, education, and nonprofit sectors in our community to improve the system of care for community youth.

Under the direction of community leaders and rooted in place-based traditions and culture, this work details the effort of a Hawaiian community to make clear its own priorities and values around health and well-being, directly in response to the outside systems and metrics that have failed to uplift the gifts and abundance of this place.

The Kaiona Framework detailed in this work serves as the foundation for subsequent efforts of our collective: (a) creating novel quantitative and qualitative methodologies to assess health status and program impact based on local traditions and values; (b) formalizing and assessing a referral system for pediatric patients in our local community health center to culture-based programming to address mental health and chronic health needs; and (c) catalyzing partnerships across the healthcare, education, and nonprofit sectors in our community to improve the system of care for community youth.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Investing the time and effort to listen to authentic community voices may reveal bold, creative, and impactful solutions to critical problems such as youth mental health and chronic health conditions that are already operating in communities.In prioritizing the values, traditions, assets, and leaders unique to a place, broader systems such as healthcare, education, and the nonprofit sector can tailor public health interventions to communities.

Investing the time and effort to listen to authentic community voices may reveal bold, creative, and impactful solutions to critical problems such as youth mental health and chronic health conditions that are already operating in communities.

In prioritizing the values, traditions, assets, and leaders unique to a place, broader systems such as healthcare, education, and the nonprofit sector can tailor public health interventions to communities.

The place and people of Waiʻanae, Hawaiʻi, are rich in connection with ʻāina (natural environment) and culture. Counter to this strengths-based approach, metrics and narratives imposed by outside systems assess many communities like ours as “sick”, “poor”, or “unwell”. This paper details our community’s approach to defining “well-being” around the values specific to our place, overseen by a council of community leaders with decades of experience supporting youth. The development was a mixed methods process including formal focus groups, informal community conversations, review of existing models, and collaboration with a professional artist. Centering community was the priority through each phase, engaging youth, parents, cultural practitioners, healthcare providers, and educators. Our community built the Kaiona Framework around the moʻolelo (traditional story) of Kaiona who helps the lost find home through empathy and compassion. Well-being is grounded in connection to, in relationship with, and in service to ʻāina. The child is at the center of our work, but inseparable from the family, community, and wider nation of people. Wellness comprises four values vital to our community: mauli ola, a balanced state of physical, mental, emotional, spiritual, and environmental health; waiwai, abundance and prosperity; pilina, mutually sustaining relationships; and ea, self-determination and agency.