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SECTION 3 Oceania


Tips and Strategies for Nutrition Counseling and Care of Native Hawaiians and Pacific Islanders


Use the cultural encounter questions on page 41 and 42 to help assess individual food and health practices.


Communication Be cautious to avoid generalizing or stereotyping NHPI people and their cultures, which are diverse and unique. Deep roots of colonization within these Indigenous NHPI cultures can lead to misconstruing traditional values, beliefs, and practices—and potentially to explicit or implicit bias and lack of respect.


If possible, learn and appropriately say thank you or a basic greeting in the person’s native language. For example, “mahalo,” used mainly in Hawaiʻi, is an expression of gratitude. Refer to page 101 for language resources. Allowing time for silence throughout conversation should be seen as progressive rather than uncomfortable during interaction.


Understand and respect gender roles in the different NHPI cul- tures, such as in American Samoa and Chuuk, where men often refrain from sharing information with women and women refrain from speaking when (Chuukese) men are present.


Establish neutral body language to demonstrate respect, for example, achieving and maintaining eye contact. For many NHPIs in the Freely Associated States of Micronesia, eye contact is perceived as offensive and disrespectful. In Chuuk, women should not be at a higher level than a man—for example, a woman standing when a man is sitting should find a seat at the same level or on the floor.


Understanding of Health Conditions NHPI people often view health from a much more holistic view than is seen in Western society. It can be helpful to begin coun- seling sessions by asking what they know about their condition, including if they have family members or know anyone that lives with the condition.


Be aware that many NHPI people may be shy and may not want to burden their health care providers with questions. If you have a trusting relationship, they will likely be very appreciative of information and education on health issues.


Use a talk story approach, which can be described as a conversa- tion pattern that integrates narration and joking in a contrapuntal (or contrasting) style and is common practice among NHPIs.45,46 The talk story approach uses open-ended questions, rather than questions that can be answered with yes or no. Avoid stacking concepts and questions and allow time for pauses and reflection.


Use of Complementary and Alternative


Medicine Consider that traditional healing represents an important cultural activity that can produce valued health outcomes and a way to pre- serve traditional culture. NHPIs often seek the services of traditional healing practitioners when ill or feeling a health imbalance and may use traditional healing treatments along with Western medicine.30


Native Hawaiian healing practitioners may use laʻau lapaʻau (herbal medicine using native plants to heal), hoʻoponopono (to make right through prayer, discussion, confession, and mutual restitution and forgiveness), and lomilomi (to mitigate or ease pain with massage) to alleviate pain and realign health.


In Guam and the CNMI, the role of traditional medicine healer, or suruhåna (female)/suruhånu (male), in many cases, is a gift passed through family generations. Traditionally, the suruhåna/ suruhånu applies an integrated system of healing that involves medicinal plants, massage, body lotion, or dietary advice.47


Family Demands and Dynamics Acknowledge relationships with family and the community in coun- seling sessions with people of NHPI descent. Consider involving the whole family and include a home visit whenever possible.


Kūpuna (elders) living within a multigenerational household may be the primary cooks of the family. Involving them in the counsel- ing process may be helpful to encourage healthy changes while still upholding cultural cooking traditions.


Consider providing group nutrition services to incorporate a sense of community if the individual is involved within their community. Services may be well-received if provided in churches, community centers, schools, or shipping centers that are readily accessible in the community. Keep in mind that in some NHPI cultures, groups may need to be separated by gender to follow cultural etiquette and allow for individuals to participate more freely.


Nutrition Counseling Promoting traditional foods and food-related practices—whether Indigenous or newly adopted, and on the islands or in the con- tinental US—can be a positive approach when counseling those with NHPI heritage. Including cultural practices, such as encourag- ing connections with the land or sea and eating traditional foods, can help to support dietary behavior changes.36


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