"Allowing space for voice…all our voices:" Understanding Ho'ouna Pono implementation through educational leadership perspectives in rural Hawai'i schools.

Epidemiological research over the past two decades has highlighted substance use disparities that affect Native Hawaiian and Pacific Islander youth, and the lack of effective approaches to address such disparities (Okamoto et al., 2019). The Ho'ouna Pono curriculum is a culturally grounded, teacher-implemented, video-enhanced substance use prevention program that has demonstrated efficacy in rural Hawai'i in a large-scale trial (Okamoto et al., 2019). Despite its potential to ameliorate health disparities and address youth substance use, prevention programs such as Ho'ouna Pono have been poorly disseminated and implemented across Hawai'i, raising the question: The present study used concept mapping to understand previously identified implementation barriers and develop implementation strategies for Ho'ouna Pono. Seven Hawai'i Department of Education (HIDOE) educational leaders and administrators sorted Ho'ouna Pono implementation barriers (e.g., "There is a lack of HIDOE funding to support prevention curricula"), named concepts, and rated barriers' perceived impact and difficulty. Multidimensional scaling and cluster analysis yielded a five-cluster solution: (1) Kumu (Hawaiian word for teacher) Controlled, (2) School Level Buy-in, (3) Curriculum, (4) Student Attitudes + Mindsets (Family + Community), and (5) Policy. Participant ratings identified eight high-impact and low-difficulty barriers. Discussion revealed important intersections among barriers indicating the need for coordinated and cross-level implementation strategies to support Ho'ouna Pono sustainment. Brainstormed implementation strategies using participants' own language highlighted a need for participatory methods in school settings to bidirectionally share ways to best sustain substance use prevention programs.