Native Hawaiians frequently prefer to access health services located within their own community or to engage in group-based health approaches. Group activities involving education, screening, exercise and the initiation of other lifestyle changes can facilitate both increased participation and success. For example, the Hawaiian Civic Clubs have actively been involved in providing health care screening for their members during annual meetings. Community health workers, especially in rural communities, are invaluable members of the healthcare team as they are known and trusted members of the community and often have intimate knowledge of resources and challenges occurring at the local level. Whether these group-based approaches are sustainable over time is still unclear although anecdotal evidence suggests that naturally occurring support mechanisms vis-à-vis grass root communities can be effective in facilitating long term public health improvements.