Native Hawaiian Cultural Considerations for Substance Use Treatment Interventions: A Scoping Review

Background and Purpose: Substance Use Disorders (SUDs) are a grave concern in the U.S. Although many factors influence substance misuse, for many Indigenous populations such as Native Hawaiians, SUD is a symptom of profound cultural, historical, and intergenerational trauma. In Hawai‘i, current SUD interventions for adults continue to be heavily based in Western contexts and use Western concepts that focus on the individual. For Indigenous populations, it is essential to recognize the value of healing-centered engagement, a strength-based, holistic approach that focuses on collective group experiences, rather than solely on an individual's experience. Questions remain as to the best way to design culturally and historically informed SUD interventions for Native Hawaiians.

Methods: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Relevant academic databases were searched with no date restrictions, as well as relevant gray literature. The search strategy was developed using the Population, Concept, Context framework: the population of interest was Native Hawaiians, the concept was Native Hawaiian cultural considerations, and the context was SUD interventions for adults. Inclusion criteria were 1) written in English, 2) focused on Native Hawaiians, and 3) reported on cultural considerations or values to inform work with Native Hawaiians who have or have had substance use issues. Data gathered included author, title, date, type of document, recommended cultural activities for SUD treatment, and states of being these activities aimed to promote. A concept map was developed that integrated the six domains of the Kūkulu Kumuhana Framework for Native Hawaiian wellbeing, culturally based treatment activities, and states of being promoted through these activities.

Results: Treatment activities and states of being were placed into one or more of the Kūkulu Kumuhana pillars. The treatment activities were placed into the categories: Kahiko, Hana hoʻohanohano, ʻAno, ʻĀina, Kai, Ola, and Western-Influenced Activities. The states of being were categorized into intrapersonal vs. interpersonal states. 278 articles were retrieved. Based on inclusion and exclusion criteria, seven articles were included for analysis. The top two activities identified were hoʻoponopono and variations of ʻāina work. The most frequently reported states of being identified were ahonui, kūpono, and hoʻomanawanui.

Discussion: The results of this review suggest that SUD interventions for Native Hawaiians should provide a number of cultural activities with the aim of helping clients develop a number of positive states of being. Thirty-one cultural activities were identified that could be further researched to determine efficacy as strong cultural considerations for treating mental and behavioral health issues. Native Hawaiian culturally based treatment necessitates a culturally based approach. Thus interventions should be facilitated, implemented, and supervised by the appropriate correlating kumu or kahuna to minimize risks and improve program experiences.

Limitations and Recommendations: The limitations of this project include 1) narrowly defined inclusion and exclusion criteria, and 2) articles written and published in English. A recommendation is to conduct further pono research to refine the current list of cultural activities and states of being discussed.