An examination of the evolution and implementation of Native Hawaiian cultural practices in the treatment of adult substance use or co-occurring mental health and substance use disorders: an organization case study

Abstract

This case study examined the implementation of Native Hawaiian Cultural Practices (NHCPs) to understand why and how one organization identified, developed, and implemented these practices to address substance use or co-occurring mental health disorders among Native Hawaiian adults, and key factors that impact the implementation process. Qualitative methods used included semi-structured interviews, focus groups, review of documents and archival records, and casual observation. Study participants were recruited from a community-based organization that used NHCPs and Western addiction practices in the treatment of substance use. Participants included administrative staff (n=4), program staff (n=5), and Native Hawaiian consumers (n=15). Content analysis was used to identify 488 codes, 23 subthemes, 3 themes, and 1 overarching theme. The three themes (key factors) identified included: 1) Pilialoha or loving relationships people maintain with each other, with places, and with spirituality, 2) Kohoʻia or identity as a predestined concept, and 3) ʻĀkoakoa or organizational integration that acknowledges similarities, differences, and areas in which Hawaiian and Western cultures blend. As the overarching theme, Piliʻana or connections characterize the Hawaiian universe as a continual movement of asking permission, engaging, and mutual benefit binding people, land, and spiritual realms together. Other key findings included: wahi pana or place-based knowledge and resources such as the significance of cultural kūpuna or elders, relational harmony such as pono or morality and justice and lōkahi or unity, the expansive nature of values that reinforce an individual‟s connection to communal life, the transferability of a healthy code of conduct from ʻāina or land interactions to human interactions, an extended period of time to plan with communities, the influential role of organizational leadership in diffusion of an innovation, and spirituality and faith as important implementation factors. These findings suggest social workers have an opportunity to implement novel programs responsive to the cultural needs of indigenous populations at greatest risk for substance use or co-occurring disorders by incorporating their epistemic worldview to increase program utility, improve recovery outcomes, and facilitate healing. At the same time, social workers must continually assess organizational key factors that impact the implementation of an innovation to become routine practice.