Culturally relevant physical activity in Hawai'i: outrigger canoeing across an adapted social-ecological model.

Outrigger canoe paddling ("paddling") is a culturally and regionally relevant physical activity (PA) in Hawai'i and the Pacific with potential for public health promotion and disease prevention, yet paddling remains understudied from a public health perspective. This study explored the meaning of paddling across levels of the social-ecological model (SEM) using qualitative methods. The study goal was to develop a research base and inform scholarship about participation in paddling for public health. A total of 1066 Hawai'i residents (18 + years) completed an online or phone survey about culturally relevant PA. Among them, 362 self-identified as current or former paddlers and responded to the open-ended question: 'What does outrigger canoe paddling mean to you?'. Qualitative analysis was conducted using a deductive-inductive approach. Findings revealed themes spanning an adapted SEM: (i) intrapersonal-fun, relaxation, PA; (ii) proximal connections-relationships with people past and present; (iii) distal connections-teams, canoe(s), and the ocean "humanized" as part of the community; (iv) environmental-immersion in the natural world; (v) macrosocial-culture, traditions, ancestral knowledge; and (vi) spiritual-life symbolism and spirituality. Many respondents reported multiple levels of the SEM in their responses, which can be seen in this illustrative quote, sharing that padding meant: '…physical health, emotional balance, spiritual connection with ocean and self, building trust and communication with a team.' Paddling fosters health, well-being, and community across SEM levels, making it a strong candidate for PA interventions aligned with best-practice public health guidelines.