Pacific Islands Countries and Territories’ (PICTs) has one of the richest and most complex ecosystems globally, surrounded by oceans with marine and terrestrial diversity. These diverse ecosystems are essential for the well-being of Pacific Islanders in terms of their livelihoods, food security, recreation and cultural activities; and they are also integral to Islanders’ heritage and identity. The well-being and cultural heritage of the Pacific Islanders are under threat from severe climate change-related impacts; and this is further compounded by several non-climate-change related factors such as overfishing and pollution, all negatively impacting the countries’ ecosystems. These negative impacts include: ecosystem degradation, loss of ecosystem services, and biodiversity loss. Therefore, a nature-based approach such as ecosystem-based adaptation (EbA) can be a useful tool in adaptation planning for the PICTs. PICTs have identified EbA as a more sustainable way towards addressing the impacts of climate change due to its costeffectiveness and suitability to the Pacific Islands countries. This is because EbA is a nature-based approach, and its implementation necessitates the involvement of the communities and/or resource owners. EbA projects in the Pacific region have been piloted in Fiji, Vanuatu, Solomon Islands and Samoa. An analysis of the results from the four Island nations’ pilot projects revealed that knowledge integration is a significant factor in decision-making under a social-ecological system where the technical or scientific knowledge and the traditional or indigenous knowledge complement each other and, in many cases, validates the indigenous knowledge. However, as PICTs’ economies depend mainly on ecosystem services, both on land and in the ocean for individual and community wellbeing, more research is warranted to further understand how EbA practices best integrate food security and livelihoods.