Improving Access to Physical Activity: Revitalizing the Old Kona Airport Walking/Jogging Path

Environmental approaches to increase access to physical activity facilities are recommended for promoting physical activity. People with easy access to recreational facilities are more likely to achieve the recommended levels of physical activity, and neighborhoods that are walkable and provide access to public parks and jogging trails are associated with higher levels of activity. Friends for Fitness, a grassroots organization in West Hawai‘i spearheaded a community-based planning process and intervention to revitalize the Old Kona Airport into a walking/jogging trail. Through community engagement, support from local media and businesses, and volunteers, Friends for Fitness succeeded in increasing physical activity among residents. After three years, the number of walkers utilizing the trail increased more than 20%

Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai‘i Federally Qualified Health Centers: a qualitative descriptive study

Objective The objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for Federally Qualified Health Center (FQHC) patients in Hawaiʻi, an ethnically diverse state with a high proportion of Native Hawaiians and Pacific Islanders (NHPI).Research design and methods We used a qualitative descriptive approach. First, we conducted a document review of existing programmatic notes and materials followed by video interview calls with 13 lifestyle coaches at 7 FQHCs implementing in-person LCPs. Lifestyle coaches catalogued, described and explained the rationale for adaptations. The research team counted adaptations if they met a specific adaptation definition derived from several sources. Community and cultural relevancy of adaptations were analysed using an existing framework for weight loss and diabetes prevention for NHPIs.Results The average number of adaptations per FQHC was 8.61 (range: 4–16). Adaptations fell into 11 broad categories such as off-site community field trips, food-related and nutrition-related activities, and physical activity opportunities. Novel adaptations included goal setting with motivational interviewing and dyadic recruitment. Field trips and in-class food demonstrations addressed the most constructs related to weight loss and diabetes prevention for NHPI, including social and community barriers, familial barriers and barriers to self-efficacy.Conclusions Lifestyle coaches were culturally attuned to the needs of LCP participants, particularly from NHPI communities. Policy-makers should recognise the extra work that LCP coaches do in order to increase enrollment and retention in these types of programmes

Increasing Access to Places for Physical Activity Through a Joint Use Agreement: A Case Study in Urban Honolulu

BackgroundTo increase levels of physical activity (PA), interventions that create or enhance access to places for PA are recommended. Establishing a joint use agreement is one way to increase access to existing PA and recreational facilities. The purpose of this article is to present a case study of In-Motion, a pilot joint use agreement project at one urban high school in Honolulu, Hawaii.ContextResidents of urban Honolulu are underserved by the amount of parkland and recreational facilities available for their use. The Honolulu County Department of Parks and Recreation sought to implement a joint use agreement to use the facilities of one urban high school for a recreational program. The high school selected for the pilot project has a student population primarily from low-income and ethnic minority backgrounds.MethodsAn assessment of the potential of 7 urban high schools to implement a joint use agreement was conducted to select the pilot site. In-Motion developed and implemented a joint use agreement. PA preferences of students, staff, and community members were assessed to guide recreational program offerings. Various recreational classes were offered free to the school community.ConsequencesSeveral barriers to implementing the joint use agreement and recreational program were encountered. However, participants were satisfied with the recreational classes they attended and said that the In-Motion program helped them to engage in more PA. Program awareness by high school students and staff was high.InterpretationIn-Motion has successfully modeled a pilot joint use agreement and provided new opportunities for PA to the high school’s students, teachers, and staff, and to community residents

Real‐World Evaluation of an Automated Algorithm to Detect Patients With Potentially Undiagnosed Hypertension Among Patients With Routine Care in Hawaiʻi

Background This real‐world evaluation considers an algorithm designed to detect patients with potentially undiagnosed hypertension, receiving routine care, in a large health system in Hawaiʻi. It quantifies patients identified as potentially undiagnosed with hypertension; summarizes the individual, clinical, and health system factors associated with undiagnosed hypertension; and examines if the COVID‐19 pandemic affected detection. Methods and Results We analyzed the electronic health records of patients treated across 6 clinics from 2018 to 2021. We calculated total patients with potentially undiagnosed hypertension and compared patients flagged for undiagnosed hypertension to those with diagnosed hypertension and to the full patient panel across individual characteristics, clinical and health system factors (eg, clinic of care), and timing. Modified Poisson regression was used to calculate crude and adjusted risk ratios. Among the eligible patients (N=13 364), 52.6% had been diagnosed with hypertension, 2.7% were flagged as potentially undiagnosed, and 44.6% had no evidence of hypertension. Factors associated with a higher risk of potentially undiagnosed hypertension included individual characteristics (ages 40–84 compared with 18–39 years), clinical (lack of diabetes diagnosis) and health system factors (clinic site and being a Medicaid versus a Medicare beneficiary), and timing (readings obtained after the COVID‐19 Stay‐At‐Home Order in Hawaiʻi). Conclusions This evaluation provided evidence that a clinical algorithm implemented within a large health system's electronic health records could detect patients in need of follow‐up to determine hypertension status, and it identified key individual characteristics, clinical and health system factors, and timing considerations that may contribute to undiagnosed hypertension among patients receiving routine care