Abstract Body: Background:
Native Hawaiians (NHs), especially those living on homesteads, face disproportionate burdens of obesity, type 2 diabetes, hypertension, and dyslipidemia. Structural inequities and reduced access to healthy foods contribute to these disparities. Partners for Improving Lifestyle Intervention (PILI) Aina (land) is a multilevel intervention designed to improve diet and cardiometabolic health by integrating individual, household, and community strategies rooted in NH culture.

Methods:
At the individual and household level, we are conducting a group-randomized trial with 180 NH adults who have overweight or obesity and at least one cardiometabolic condition. At the individual level, all participants complete a 3-month, culturally adapted Diabetes Prevention Program–Lifestyle Intervention. Individuals are then randomized. They and their household receive either standard follow-up or PILI Aina, which includes raised-bed gardening, family goal setting, and monthly cooking and cultural lessons. The PILI Aina primary outcome is changes in overall diet quality (e.g., Healthy Eating Index score). Secondary outcomes include changes in weight, BMI, blood pressure, HbA1c, lipid profiles, physical activity, household food patterns, and social cohesion. Homestead communities also implement Ai Pono (healthy eating), community-wide, quarterly cooking demonstrations of healthy diets with cultural teachings. The Ai Pono outcomes are social cohesion and household food patterns. Data are collected at baseline, 3, 9, and 12 months (PILI Aina) and annually across communities (Ai Pono).

Results:
Enrollment and implementation are ongoing. Pilot data support feasibility and suggest improvements in diet, weight, blood pressure, and activity. Early Ai Pono events have been widely attended and enthusiastically received.

Conclusions:
This multilevel intervention combines household and community strategies to reconnect NH on homestead lands with cultural ideas related to eating and food, boost fruit and vegetable intake, and enhance cardiometabolic health. PILI Aina is among the first NH-specific trials to blend an evidence-based lifestyle curriculum with a home gardening and cooking program focused on food sovereignty. By embedding the intervention within NH homestead communities and aligning with cultural principles of ohana (family) and malama aina (caring for the land), we expect strong community engagement and sustainability.