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Self identity through Ho'oponopono as

adjunctive therapy for hypertension

Article in Ethnicity & disease · February 2007

Source: PubMed


8 188

5 authors, including:

David Easa Rosanne C Harrigan

University of Hawaiʻi at Mānoa University of Hawaiʻi at Mānoa


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Objective: Self Identity through Ho’opono- Kikikipa Kretzer, PhD; James Davis, PhD; David Easa, MD;
pono is a step-by-step problem-solving ap- Julie Johnson, PhD; Rosanne Harrigan, EdD
proach to identify and relieve stress. The
objective of this study was to determine if Self
Identity through Ho’oponopono along with
standard medical therapy might better control INTRODUCTION
hypertension than standard therapy alone.
In this study, we hypothesized
Our article describes an initial study
Design, Setting, Participants: Twenty-three
Asian, Hawaiian, and other Pacific Islanders
of Self Identity through Ho’opono- that a better understanding of
pono, which is a spiritual intervention
from a local community in Hawaii participated
in a longitudinal design comparing pre- and developed in Hawaii to identify and
self, gained by attending a class
post-intervention measures of blood pressure. relieve stress. It is a method of caring for on Self Identity through
the self through the process of re-
Intervention: Participants attended a half-day
pentance, forgiveness and transmuta- Ho’oponopono, may help
class on Self Identity through Ho’oponopono
to learn ways to create balance and correct tion. Self Identity through Ho’opono- control high blood pressure.
stress through an understanding of their own pono is also an approach to develop
self identity. Participants learned processes to a better working relationship among the
care for themselves through repentance, for- conscious mind, the subconscious, and
giveness, and transmutation and how to apply
the superconscious (mind, body and enrolled into the study, primarily from
the processes in their daily lives.
spirit) allowing individuals to under- Asian, Hawaiian and other Pacific
Main Outcome Measures: Repeated blood stand themselves better. The word Islander populations. All were
pressure measurements were compared be- ‘‘Ho’oponopono’’ means ‘‘to make .30 years of age and had prehyperten-
fore and after the intervention using general-
right, to rectify, and to correct.’’1–3 sion or hypertension. Persons were
ized estimating equations; two spirituality
Adherents of the intervention believe excluded who were pregnant, incarcer-
questionnaires were administered before and
after the intervention and analyzed with paired that the more the mind, body, and spirit ated, planning to relocate from Hawaii,
t-tests. work together, the more the individual likely to have significant medication
will release sources of stress, tension, changes, or had increased risk for
Results: Systolic blood pressure decreased serious disease or death (such as those
and conflicts that may affect health. In
after the intervention, averaging 11.86 mm with terminal illnesses or enrolled in
Hg below pre-intervention levels. Diastolic
this study, we hypothesized that a better
blood pressure decreased by 5.44 mm Hg. understanding of self, gained by attend- a hospice program). The study was
Spirituality scores significantly increased after ing a class on Self Identity through approved by the University of Hawaii
the intervention. Ho’oponopono, may help control high Institutional Review Board.
blood pressure. The class was offered to
Conclusions: Self Identity through Ho’opono- Recruitment
pono was associated with a statistically and participants with prehypertension and
clinically significant reduction in mean blood hypertension as an adjunct to standard Methods of recruitment included
pressure. Spirituality scores increased after the medical therapy. fliers, announcements at public meet-
intervention. We conclude that Self Identity ings, word of mouth communication
through Ho’oponopono may be an effective and telephone calls, provider referrals,
adjunctive therapy for hypertension. Further and booths set up at community events.
research is needed to validate these prelimi- METHODS
nary findings. (Ethn Dis. 2007;17:624–628)
Presentations were conducted at senior
centers, health fairs, churches, shopping
Study Design malls, dental offices, pharmacies, and
Key Words: Self Identity Ho’oponopono,
Participants served as their own
Hypertension, Spirituality a variety of other settings. The re-
controls in a pre-test/post-test longitu-
cruitment process was open to all adults
dinal design. Twenty-three adults were
regardless of their perceived level of
spirituality, and no one was denied
From the University of Hawaii at Manoa access to the study for personal views.
(KK); the John A. Burns School of Medicine, Address correspondence and reprint re-
University of Hawaii at Manoa, Honolulu, quests to: Kikikipa Kretzer, PhD; University of
Hawaii (JD, DE, RH); and the School of Hawaii at Mãnoa; POB 240035; Hono- Procedures
Nursing at New Mexico State University, lulu, HI 96824; 808-590-9444; kretzer@ At the initial visit, demographic,
Albuquerque, New Mexico (JJ), USA. hawaii.edu health, and spiritual profiles were com-

624 Ethnicity & Disease, Volume 17, Autumn 2007


pleted by participants. Two spirituality professional-quality blood pressure variable, identifying if the measurement
questionnaires pertaining to each partic- monitors. The accuracy of these devices was taken before or after the interven-
ipant’s sense of spirituality were admin- met or exceeded SP10-1992 Association tion, served as the independent variable.
istered at the start and the end of the for the Advancement of Medical In- Results from the models estimated the
study for pre- and post-test comparisons. strumentation standards.4,5 difference in pre- versus post-test blood
Up to nine blood pressure measurements Spirituality was assessed by using pressure values. The models included
were obtained at approximately one- two questionnaires. The first, the Spir- four pre-post comparisons. As the
week intervals. The pre-test blood pres- itual Orientation Inventory, is com- primary objective, pre-intervention
sure readings began at enrollment, a time posed of 85 items on a seven-point blood pressure measurements were com-
#45 days before the intervention class. Likert-type scale. The items reflect nine pared to measurements taken over the
Follow-up blood pressure measurements domains of spirituality,6 and this ques- two months post-intervention. In other
extended two months after the interven- tionnaire was chosen both because it analyses, pre- and post-intervention
tion. Participants scheduled appoint- measures spirituality alone and not measurements were compared on the
ment times for blood pressure assess- religiosity and because it contains day of the intervention, and measure-
ments at prearranged meeting locations, themes consistent with commonly oc- ments taken during the first and second
such as senior centers and the local health curring themes of spirituality. The months after the intervention were
clinic. If a participant missed a blood second measure of spirituality was the compared separately to the pre-inter-
pressure measurement visit, follow-up Supplemental Spirituality Question- vention blood pressure measurements.
phone calls were made to reschedule naire. This instrument is composed of The scores generated from the two
appointment times. The same investiga- 14 scales on a seven-point Likert scale spirituality questionnaires were analyzed
tor supervised all measurements and and a qualitative item, ‘‘Tell me how using paired t-tests.
measured blood pressure for most par- you feel about your own spirituality
ticipants. today.’’ These scales measured each
At each appointment, participants participant’s sense of spirituality RESULTS
were encouraged to rest for five minutes through inquiries regarding well-being,
before the blood pressure measurements. meaning and purpose in life, forgive- Eighty-three percent of the partici-
They were instructed to sit quietly in ness, peace, and love. pants were $50 years of age, 70% were
a chair with their backs straight against female, 65% were Hawaiian or part
the seat back, feet flat on the floor, and Intervention Hawaiian, and 22% were of Asian
arm at heart level. An appropriate-sized The study intervention Self Identity descent (Table 1). All participants
bladder cuff encircling 80% of the through Ho’oponopono was offered were long-term residents of Hawaii
individual’s upper arm was used. Three during a four-hour class. The instructor ($6 years). No participants were preg-
measurements were obtained for each used a series of lectures, discussions, nant, and none required the use of an
visit, and whenever possible, participants problem-solving interactions, sharing of interpreter. All of the participants were
had their blood pressure monitored from processes or tools, and question-and- ambulatory, able to communicate ver-
the same arm at all visits. Participants answer periods as teaching methods. bally, and able to write independently.
were instructed to seek medical care if Participants were taught simple pro- Thirty-five percent (8/23) reported a di-
blood pressure was higher than normal cesses, such as breathing exercises, agnosis of diabetes mellitus in addition
or if they experienced symptoms such as prayers, and meditation. The partici- to prehypertension or hypertension, and
chest pain, palpitations, dizziness, or pants were told they might incorporate 9% (2/23) had a history of asthma. Six
visual changes. Throughout the study, them in their daily lives, but post- participants reported histories of other
participants were instructed to continue intervention practice was not required health conditions: prior myocardial in-
with their usual medical therapy and to or monitored and was left to the farction, pacemaker, cerebral vascular
maintain their regular diet and exercise participants’ discretion. attack and mini-stroke (1); deep vein
patterns unless advised otherwise by their thrombophlebitis and Greenfield filter
health practitioner. If a change did occur, Statistical Analyses (1); bleeding (unspecified) (1); breast
participants were further instructed to Blood pressure measures were ana- lump (1); epilepsy (1); and Meniere’s
note such changes in their study diary. lyzed using generalized estimating equa- Disease, obesity, hypothyroidism and
tions and were identified in the analyses alcoholism (1).
Variables as repeated measurements.7,8 In the Fifty percent of participants re-
Blood pressure measurements were regression models, blood pressure was ported involvement in some form of
obtained using two automatic, digital, the dependent variable. An indicator physical exercise; 26% reported they

Ethnicity & Disease, Volume 17, Autumn 2007 625


antihypertensive agents including 11.86 mm Hg lower at the second

Table 1. Demographic Characteristics
at Enrollment diuretics, betablockers, angiotensin in- month after the intervention. Similarly,
hibitors, calcium channel blockers, an- mean diastolic blood pressure was
CHARACTERISTIC VALUE* giotensin receptor blockers, or a combi- 4.16 mm Hg lower at the first month
Age (years) 59.5611.2 nation of anti-hypertensive agents. Five after the intervention and 5.44 mm Hg
Gender participants reported antihypertensive lower at the second month. Mean blood
Female 16 (70%) medication changes: two reduced doses, pressure increased on the intervention
Male 7 (30%) two switched drug classes, and one day itself. Figure 1 illustrates the pat-
Ethnicity initiated medication. terns of change for all of the systolic and
Hawaiian/part Hawaiian 15 (65%) Participants were also asked about diastolic blood pressure comparisons.
Asian 5 (22%)
their spirituality with the meaning of The spirituality measure increased
Caucasian 2 (9%)
Other 1 (4%) spirituality left to individual interpreta- <.3 units after the intervention. Results
Weight (lb)
tion. Most (86%) participants consid- are based on scores of 21 of the 23
Female 180649 ered themselves to be spiritual; 22% participants who completed both pre-
Male 235692 viewed themselves as ‘‘totally’’ spiritual; and post-intervention questionnaires.
Years living in Hawaii 47.6619.4 78% viewed their spirituality as ‘‘aver- The mean (plus or minus standard
* Values are given as mean 6 standard deviation or
age.’’ Recurring themes in the responses deviation) pre- and post-intervention
n (%). to the qualitative, spirituality-related scores of the Spiritual Orientation
question included a belief in a higher Inventory were 5.426.81 and
power and an affirmative awareness of 5.706.67(P5.02, 95% CI 5 0.06,
engaged in regular aerobic physical spirituality. The participants all consid- 0.51). For the mean pre- and post-
activity for 30 minutes daily (Table 2). ered spirituality important to health. intervention scores on the Supplemental
Most reported healthy choices such as The mean differences in repeated Spirituality Questionnaire, pre-inter-
limiting their alcohol intake and con- pre- and post-intervention blood pres- vention scores were 5.6761.23 com-
suming low-fat foods. Nearly all (87%) sures decreased significantly each month pared to post-intervention scores of
considered themselves active partici- after the intervention of Self Identity 5.986.99 (P5.01, 95% CI 5 0.09,
pants in their health care and indicated through Ho’oponopono (Figure 1, Ta- 0.53).
a desire to become more involved in ble 3). The mean systolic blood pressure
their healthcare experience (91%). was 7.83 mm Hg lower at the first
Seventy-four percent reported taking month after the intervention and

Table 2. Health and Spiritual Profiles at Enrollment Our results suggest that Self Identity
through Ho’oponopono may have ben-
Question Reply Frequency (%) eficial effects on blood pressure control.
Spiritual Questions Mean systolic and diastolic blood pres-
Do you consider yourself spiritual? Yes 19 (86%)* sures both decreased after the interven-
No 3 (14%)
Please rate your level of spirituality. About average 18 (78%) tion. The magnitude of effect for these
Totally spiritual 5 (22%) changes was comparable to those of
Do you sense spirituality is important to your health? Yes 22 (100%)* published trials of an exercise interven-
tion.9–12 The repeated measures study
Health-related Questions
Do you smoke? Yes 1 (4%) design using participants as their own
Are you currently exercising? Yes 11 (50%)* controls was chosen to avoid confound-
Do you engage in regular aerobic physical activity for 30 Yes 6 (26%) ing by patient characteristics, which
minutes/day most days of the week?
Do you limit alcohol consumption to no more than 1 oz (30 mL) Yes 19 (83%)
remained consistent over the study
of ethanol/day if male, and K oz. (15 mL) if female? period. Examples of such characteristics
Do you consume low-fat foods? Yes 15 (65%) include socioeconomic status, general
Do you have a family history of high blood pressure? Yes 21 (91%) health, and family structure. A smaller
Are you taking prescription medication for hypertension? Yes 17 (74%)
Are you actively involved in caring for your health? Yes 20 (87%)
sample size was possible for this pre-
Would you like to be more involved in your healthcare treatments? Yes 21 (91%) liminary study using this approach than
* Frequencies are based on 22 of the 23 participants. with a design requiring a control group.
Furthermore, all participants were of-

626 Ethnicity & Disease, Volume 17, Autumn 2007


Fig 1. Illustration of post-test differences in diastolic and systolic blood

fered the intervention, which encour- bias, including those from potential system to produce catecholamines,
aged participation in the study. regression to the mean and from which can cause vasoconstriction.14
Several limitations of the design, medication changes. Thus, a normalization of blood pressure
however, may have affected the results. In terms of the potential mechanism may result through several mechanisms
With the pre-test versus post-test de- of action as to how this intervention when stress level is decreased. Increased
sign, a regression to the mean could may affect blood pressure and improve spirituality may be seen as a second
have occurred. Nearly all participants, health, we speculate that a feasible benefit of the intervention. Whether the
however, had sustained high blood reduction in stress is experienced changes in spirituality scores and blood
pressure before the start of the study. through Self Identity through Ho’opo- pressure are interrelated cannot be
Participant selection for the study was nopono and may be mediated at the assessed by this pilot design.
not based on short-term hypertension mental, physical and spiritual level Whatever the possible mechanism,
measurements. To be sure, participants (mind, body, spirit). Since the basis of Self Identity through Ho’oponopono
may have volunteered to participate in Self Identity through Ho’oponopono is was associated with a significant, clini-
this spiritually oriented intervention to relieve stress, this intervention may cally important reduction in blood
study because of their partiality or have resulted in lower blood pressure pressure for two months after the
beliefs in spirituality that could have through a calming effect on normal intervention, with improved spirituality
directly contributed to its success. physiology. Evidence suggests that scores. Hypertension is a health dispar-
Another limitation is that 5 of 23 chronic stress is associated with release ity in a number of disadvantaged ethnic
participants reported medication of cortisol by the hypothalamus-pitui- populations, and this intervention may
changes. These changes might have tary axis, which can contribute to be particularly relevant to individuals in
affected the results in either direction. elevations in blood pressure and an Hawaii; these populations may be
Including a control group in future imbalance in serotonin levels.13 In amenable to interventions they perceive
studies could minimize the potential addition, stress stimulates the nervous as culturally appropriate.

Table 3. Differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) comparing pre- and post-inter-
vention measurements

Post-Intervention Interval Mean SBP Difference (95% CI.) P Value Mean DBP Difference (95% CI) P value
All post-test measurements 2 6.81 (2 12.86, 2 0.76) 0.03 2 3.51 (2 6.02, 2 0.99) 0.01
Intervention day 6.35 (0.80, 11.90) 0.03 4.37 (2.05, 6.69) 0.001
First month post-intervention 2 7.83 (2 13.86, 2 1.80) 0.01 2 4.16 (2 7.42, 2 0.90) 0.01
Second month post-intervention 2 11.86 (2 20.77, 2 2.96) 0.01 2 5.44 (2 9.03, 2 1.85) 0.003

Ethnicity & Disease, Volume 17, Autumn 2007 627


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This intervention may also offer benefit Welch Allyn; 2002. Design concept of study: Kretzer, Harrigan
to people with health conditions other 6. Elkins DN, Hedstrom LJ, Hughes LL, Leaf Acquisition of data: Kretzer, Harrigan
than hypertension. A randomized clin- JA, Saunders C. Toward a humanistic-phe- Data analysis and interpretation: Kretzer,
ical trial is necessary to validate these nomenological spirituality definition, descrip- Davis, Easa, Johnson, Harrigan
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7. Laing KY, Zeger SL. Longitudinal data Statistical expertise: Kretzer, Davis, Harrigan
analysis using generalized linear models. Acquisition of funding: Kretzer, Easa
ACKNOWLEDGMENTS Biometrika. 1986;73:13–22. Administrative, technical, or material assis-
This research study was supported by 8. Lipsitz SH, Fitzmaurice GM, Orav EJ, Laird tance: Kretzer, Johnson, Harrigan
funding from the National Institutes of NM. Performance of generalized estimating Supervision: Kretzer, Davis, Harrigan

628 Ethnicity & Disease, Volume 17, Autumn 2007