“It Takes a Village (ITAV)” Expansion Project
October 2021

Utah has one of the largest populations of Native Hawaiian/Pacific Islanders in the lower 48 United States. Pacific Islanders have had a presence in Utah since the late 1800s when many Native Hawaiians moved to the Salt Lake Valley as a result of missionary efforts of the Church of Jesus Christ of Latter Day Saints and additional diasporas after World War II. Most of the Pacific Islanders in Utah are Polynesian (Tongan, Samoan, and Hawaiian). Although the population of Pacific Islanders in Utah is large relative to Pacific Islander populations in the U.S., Pacific Islanders represent a very small percentage of the total population in Utah. These relatively small numbers, coupled with Pacific Islander health data being included in the ‘Asian’ racial category for many decades, made it difficult to understand the true health disparities that exist among this population (Utah Department of Health Office of Health Disparities ‘ITAV’ Project).

Utah’s Native Hawaiians/Pacific Islanders experience significantly higher rates of infant mortality compared with other groups within the state. Prior to this project, no health promotion interventions existed in Utah (or in the U.S.) for Pacific Islanders to address birth outcome disparities. Since 2012, the Utah Office of Health Disparities, in collaboration with public health and health care professionals and community partners, has been working to address this issue. A final product of these efforts is the “It Takes a Village”: Giving Our Babies the Best Chance project. ITAV raises awareness and educates Native Hawaiian/Pacific Islander families and community members about maternal and infant health in the context of Pacific Islander cultural beliefs and practices. ITAV is one of the outcomes of a birth outcomes disparities project that was originally rooted in the theoretical framework from the National Partnership for Action to End Health Disparities.

The Need:
The ITAV project was developed and practiced with Pacific Islander groups in 2016–2017 in the Northern Utah region. In 2019, it was decided to replicate the ITAV project for the growing Pacific Islander populations in Southern Utah. The Southern Utah Pacific Islander Health Coalition (SUPIHC) was identified as a local community organization that was supportive of this proposal. Membership of SUPIHC agreed to help identify community members willing to be trained as facilitators.

Community Engagement:
Initial recruitment proved challenging because community members are often not willing or interested in discussing the topic of infant mortality. However, the project coordinator, Oreta Tupola, worked diligently and fostered authentic connections with the local community; as a result, she recruited a group of six individuals to train as project facilitators. The facilitator training and corresponding ITAV groups are as follows:  

Group of eight people standing together in a conference room

Group of St. George, Utah ITAV Trainers and Group Facilitators (from left to right): Back Row; Jacobn Maufau, Tima Clawson, Brittney Okada, Terina Taulogo, Mae Mauia-Tafuna, Jarvi Moea’I, Nale Fakahua. Front row; Sala Dela Rosa-Bridges.

It Takes A Village: St. George Pacific Island Community
Six Community Facilitators Completed ITV Train-the-Trainer Course
Task: Conduct Three Community Group Sessions
Mae Tafuna/Sala Bridges
Jacob Malufau/Jarvi Moeai
Nale Fakahua/Terina Taulogo

Completion of Three Community Group Sessions
1. Facilitators: Mae Tafuna and Sala Bridges (Face to Face) 
Month: February 2020
Number of participants: 13 
2. Facilitators: Oreta Tupola and Terina Taulogo (Zoom)
Month: December 2020
Number of participants: 4 
3. Facilitators: Oreta Tupola and Terina Taulogo (Zoom) 
Month: December 2020
Number of participants: 8
4. Facilitator: Oreta Tupola (Zoom) 
Month: December 2020
Number of participants: 6

Through these discussion groups patterned after a traditional village counsel, we found the structure of the curriculum helped participants find connections through sharing stories about relatives and siblings or discussing how they themselves had lost a child to miscarriage. One community member, who was not a mother, sought more information about infant mortality because her work focused on supporting children and families. She learned new tools to support her sisters-in-law who are still dealing with the loss of their babies. Three male participants learned how infant mortality is affecting families within their communities and are now better able to increase awareness and provide resources to young couples and families.

Lessons Learned:
The tailored curriculum worked well for facilitating discussion about topics that are not generally talked about within the community. The project team also found it critical to be flexible about their process for participation, delivery, and evaluation to reach members of the community most at risk for infant mortality. Successful strategies for recruiting participants include having project team members who are trusted in the community and offering tailored incentives. The connections through stories successfully raised awareness of infant mortality risk for those who participated in this project replication.