Pacific American elders: The salience of spirituality for health and well-being

Spirituality is often not acknowledged as a central component of health and well-being. According to Pacific cultural beliefs, when one's spiritual life is right (pono), all other aspects of health and well-being fall into place. Using principles of grounded theory for data collection and analysis, in-depth interviews were conducted with 10 Samoan and 10 Tongan elders in Hawai'i to provide a more holistic understanding of the bio-psycho-social-spiritual aspects of health and well-being. The overall research question for the study was: What are the family, community, and cultural-based factors that contribute to health and well-being for Samoan and Tongan elders? This research question was shaped by the Ho'okele model, which depicts the central role of Pacific elders as navigators for their families and communities and emphasizes the importance of intergenerational relationships and multiple systemic connections. This model allows for a more nuanced understanding of the socio-cultural contextual environment of the participants' lived experiences and its influence on health and well-being. Analysis of the data included line-by-line analysis, memo writing, and constant comparative analysis until redundancy when no new themes were discovered. Spirituality emerged as a significant theme throughout the analysis and permeated all aspects of health: 1) biological (including health status, illness, physician visits, hospitalization, insurance, diet, and exercise); 2) psychological (including stress, depression, memory loss, anxiety, loneliness, grief); and 3) social (including family and social support, recreation, and cultural responsibility). Opportunities to integrate spirituality as a component of culturally-relevant prevention and intervention strategies for Pacific American elders will be discussed.