Native Hawaiian Complementary Feeding Practices as Told by Grandparents: A Transgenerational Experience

BACKGROUND: Infancy is a significant disease prevention and health promotion stage in life. There is a need to examine factors influencing complementary feeding among Native Hawaiians through an indigenous framed lens. OBJECTIVES: To identify Hawaiian complementary feeding practices through in-depth interviews with kūpuna (grandparents) from across the state of Hawai‘i. METHODS: The chain-referral-sampling method was used to identify Native Hawaiian kūpuna knowledgeable in Hawaiian complementary feeding practices from across 4 counties in Hawai‘i. Interview question topics included sharing about their formative years, infant health, infant feeding, transgenerational knowledge, and opportunities and barriers related to traditional food consumption. Interviews were recorded and then transcribed. Three coders used NVivio12 to code transcripts using a priori and emergent themes. Institutional Review Board approval was received prior to data collection. RESULTS: Fourteen kūpuna interviews were included in the analysis. A majority of the kūpuna were female. Most kūpuna shared that complementary feeding practices in their childhood and when their children and grandchildren were being raised reflected aspects of the traditional Hawaiian diet. Poi, or steamed mashed taro root, was the most common traditional Hawaiian dietary staple of infancy. However, kūpuna shared that traditional dietary practices evolved to reflect contemporary dietary practices such as the mixing of poi with infant cereal or milk. Female family members were prominent influences on kūpuna complementary feeding practices. Lifestyle and lack of knowledge were the most commonly shared reflections by kūpuna on the supports and barriers, respectively, to promoting and engaging in traditional Hawaiian complementary feeding practices. CONCLUSIONS: Complementary feeding practices have evolved over generations but aspects of traditional Hawaiian feeding practices have remained. These findings are important when working with Hawaiian families because kūpuna play a prominent role in feeding infants.