Table 2.

Ho’ouna Pono Concept Mapping Barriers and Brainstormed Implementation Strategies

I. Kumu Controlled (CFIR Individual Characteristics and Implementation Process)		Implementation Strategies
1	The frequent turnover of teachers in my school will disrupt the ongoing implementation of Ho’ouna Pono	Coordinated and cohort-based training Curriculum integrated into existing lesson plans to address all students Drug treatment counselor, school counselor, and school-based behavioral health specialist involvement
2	The delivery of the Ho’ouna Pono curriculum is assigned to a teacher who is resistant to using the curriculum
5	The responsibility for teaching health frequently shifts from one teacher to another teacher in my school
7	It is difficult for teachers to talk about drug and alcohol use in the classroom setting with their students
15	HIDOE teachers who prefer didactic teaching methods may not feel comfortable with the interactive approach of the Ho’ouna Pono curriculum
16	Senior HIDOE teachers are comfortable with their current drug and alcohol lessons, and are therefore not interested in the Ho’ouna Pono curriculum
23	Incorporating the Ho’ouna Pono curriculum into my curriculum map will take planning and effort
25	Drug prevention curricula like Ho’ouna Pono encourage the discussion of sensitive topics, which could lead to overstepping student-teacher interpersonal boundaries
28	Some HIDOE teachers believe their current drug and alcohol content is effective, so they don’t see any added benefit to the Ho’ouna Pono curriculum
29	Some HIDOE teacher believe that drug use is symptomatic of deeper issues (e.g., depression), which should instead be the focus of prevention
31	Some HIDOE teachers believe that drug prevention curricula like Ho’ouna Pono have limited impact in promoting internalization of youth’s drug-free attitudes
33	Some HIDOE teachers feel that prepackaged curricula like Ho’ouna Pono threaten their autonomy in the classroom
39	Lack of familiarity with Ho’ouna Pono makes me hesitant to use the curriculum
45	Teachers may not use the Ho’ouna Pono curriculum, because they are afraid that it could prompt their students to ask them about their personal drug use histories
48	Some HIDOE teachers are resistant to trying new curricula like Ho’ouna Pono, because it feels like “one more thing you [administrators] want me to do in the classroom”
II. School Level Buy-in (School level; CFIR Inner Setting)
13	The implementation and training related to the Ho’ouna Pono curriculum will be difficult to fit into teachers’ busy schedules	More required health education courses in middle school Create new incentives for continuing education for teachers Align educational policies with health and well-being outcomes
20	HIDOE job performance measures (e.g., CESA) do not explicitly measure growth on student health indicators
27	There may be a lack of enthusiasm for the Ho’ouna Pono curriculum because health education is not prioritized in the HIDOE
40	HIDOE senior teachers at the top of the salary scale (Class 7) do not need PDE credits associated with implementing the Ho’ouna Pono curriculum for reclassification
41	Substance use is not perceived to be a major problem in my school
42	The frequent turnover of principals in my school will disrupt the ongoing implementation of Ho’ouna Pono
49	HIDOE administrators are resistant to endorsing Ho’ouna Pono, due to fear of asking overburdened teachers to try something new in the classroom
50	Natural disasters on Hawaiʻi Island (e.g., lava, hurricanes) disrupt school-based prevention efforts, like Ho’ouna Pono
III. Curriculum (CFIR Innovation)
3	The Ho’ouna Pono curriculum introduces terms that might be difficult for ESL students to understand	Use teachers to develop the curriculum
8	The Ho’ouna Pono curriculum is structured primarily on skill-building (e.g., decision making) rather than on teaching standard health topics (e.g., facts about drugs and alcohol)
10	The Ho’ouna Pono curriculum would require additional work for teachers in immersion schools who need to translate the lessons into Hawaiian
*21	The Ho’ouna Pono curriculum does not extensively cover current or recent forms of substance use, such as vaping
*22	After 10 years, the Ho’ouna Pono curriculum may need updating, by changing youths’ language and jargon depicted in the videos
32	The 9-lesson Ho’ouna Pono curriculum has too much drug-specific content to fit within a semester-long health course
34	The Ho’ouna Pono curriculum introduces language and concepts that may be academically advanced for the 6th grade level
*38	The Ho’ouna Pono curriculum lacks a social media presence (e.g., Twitter, Instagram, Facebook)
47	Marijuana use is socially acceptable on Hawaiʻi Island, diminishing the need for Ho’ouna Pono
IV. Student Attitudes + Mindsets (Family + Community) (CFIR Outer Setting)
9	The structure of the Ho’ouna Pono curriculum can get repetitive for some students over the course of nine lessons, affecting their engagement	Use school community councils to elevate student voice
18	Some families live a “counter-culture” lifestyle, and might not want their children exposed to drug prevention
30	The relatability of the Ho’ouna Pono curriculum is limited primarily to 6th and 7th graders. Older youth may find it to be “silly” or too “immature”
V. Policy (CFIR Outer Setting)
4	The HIDOE OCISS (State-Level) Health Resource Teacher has not explicitly endorsed the Ho’ouna Pono curriculum for Hawaiʻi island schools	Talk with legislators about curriculum
6	Mainstream publications (Honolulu Magazine) do not sue health indicators in establishing their annual rank ordering of public schools
11	The HIDOE emphasis on “moving” school-wide standards-based test scores detracts from health education and prevention efforts like Ho’ouna Pono
12	The Ho’ouna Pono curriculum does not specifically address Common Core standards in writing and math
14	Health education is not included in the middle school promotion policy, therefore there is no urgency to implement drug prevention curricula like Ho’ouna Pono
17	Shifting National priorities (e.g., bullying) take the focus away from substance abuse prevention programs, like Ho’ouna Pono
19	The Hawaiʻi Board of Education may see Ho’ouna Pono as redundant to other drug prevention curricula in Hawaiʻi Island schools, like DARE
24	Qualified adult instructors outside of the HIDOE are not available to teach Ho’ouna Pono lessons to youth
26	There is a lack of HIDOE funding to support prevention curricula like Ho’ouna Pono
35	Restrictions on federal funding (e.g., Title 1) make it difficult to support curricula like Ho’ouna Pono
36	The HIDOE emphasis on college and career readiness diverts school resources away from drug prevention programs, like Ho’ouna Pono
37	The HIDOE does not specify the structure or content of substance use prevention in schools
43	The HIDOE emphasis on vocational training diverts school resources away from drug prevention programs, like Ho’ouna Pono
44	There may be a lack of enthusiasm for the Ho’ouna Pono curriculum because health education is not a standardized or measured content area
46	The turnover of state-level administrators will disrupt the ongoing implementation of Ho’ouna Pono

Note. Numbers correspond to numbering in the original Ho’ouna Pono Implementation, Adoption, and Sustainability survey (Okamoto et al., 2020); CFIR = Consolidated Framework for Implementation Research (Damschroder et al., 2009) mapped domains next to concepts in parentheses; “School Level Buy-In” was originally named “School level” shown in parentheses;

^*indicates move from “Student Attitudes + Mindsets (Family + Community)” to “Curriculum.”