The Tapestry of Us: A Place-Based Narrative Medicine Workshop Integrating the Native Hawaiian Framework of Pilinahā

Abstract

Title: The Tapestry of Us: A Place-Based Narrative Medicine Workshop Integrating the Native Hawaiian Framework of Pilinahā

Authors: Julia Takata1, Kasen Wong1, Kalpana Balaraman1, Masako Matsunaga1, Deepu Gowda2, Teresa Schiff-Elfalan1

Affiliations: 1John A. Burns School of Medicine at the University of Hawai‘i 2Kaiser Permanente Bernard J. Tyson School of Medicine

Context Narrative medicine is a practice of clinical and pedagogical listening that equips healthcare professionals to receive and honor stories of illness with humility, empathy, and ethical responsibility. Through literary methods such as close reading, reflective writing, and facilitated group discussion, narrative medicine nurtures skills of perspective-taking, curiosity, relationship-building, and patient-centered communication. Pilinahā is a framework for health based on Hawaiʻi community members’ interpretation of health as the feeling of being whole and connected. Pilinahā is derived from the Hawaiian word, pilina, meaning connection, and the Hawaiian word, hā, which represents a dual meaning for ʻehā, meaning 4, and hā, meaning breath. The four pillars of Pilinahā are: 1. Connection to place: to have kinship with ‘āina (land) 2. Connection to community: to love and be loved; to understand and be understood 3. Connection to past and future: to have kuleana (a purpose in the world) 4. Connection to your better self—to find and know yourself

We are unaware of narrative medicine workshops fully organized around an Indigenous health framework.

Objective Demonstrate the feasibility and impact of place-based approaches in narrative medicine using the Native Hawaiian health framework of Pilinahā to promote self-awareness, professional identity formation, and interpersonal connection. Description of Innovation In collaboration with indigenous health educators, we designed and implemented a two-day workshop for 40 participants at the John A. Burns School of Medicine (JABSOM). Participants included JABSOM faculty, JABSOM students, University of Hawaiʻi graduate students, and clinicians from health organizations across the state. The final cohort included 40 participants from a range of disciplines and institutional affiliations. Each day consisted of approximately 8 hours of narrative-centered activities, including close reading of creative works, reflective writing, small-group discussion, and plenary talks. All aspects of the workshop were informed by Pilinahā, including choice of texts (e.g., local poetry, Hawaiian music), writing prompts, and activities (e.g., observation in a Hawaiian healing garden). The workshop design was co-created with Indigenous health educators.

Evaluation of Innovation Participants completed retrospective pre- and post-workshop surveys evaluating attainment of learning objectives, understanding of narrative medicine and Pilinahā concepts, and new professional identity insights. Quantitative data were analyzed using Wilcoxon signed-rank tests; qualitative data underwent thematic coding. Among 23 respondents, statistically significant improvements were observed for all survey items (p < 0.01), related to understanding of narrative medicine and Pilinahā concepts. Qualitative feedback revealed participant interest in incorporating narrative medicine and Pilinahā approaches into teaching (12), clinical practice (11), and personal enrichment (16). Participants noted increased awareness of the impact of culture and place on health, and an increased interest in building their observation, reflection, and facilitation skills to foster connections in their relationships with their students, patients, and the broader community. Strengths included cultural grounding, interdisciplinary participation, and strong faculty engagement. Evaluation was limited by selection bias and lack of a comparison group. However, the evaluation plan was focused on feasibility, acceptability, and examination of exploratory outcomes.

Discussion/Key Message Integrating Indigenous frameworks with narrative medicine pedagogy is feasible and impactful. Although Pilinahā is an Indigenous health framework local to Hawaiʻi, the importance of connection to place, people, and time is generalizable to many other settings and communities. Additionally, we feel that the model of partnering with and co-creating place-based learning with local Indigenous health experts and perspectives may be particularly productive and applicable to diverse educational settings.

Target Audience Medical educators of all disciplines (i.e. both UME and GME)