Objectives-Native Hawaiians (NHs) and Other Pacific Islanders (OPIs) bear an excess burden of diabetes health disparities. To address this, Community-based Participatory Research (CBPR) approaches were used to: 1) culturally-adapt the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) for NHOPI communities; and 2) implement and examine the effectiveness of the culturallyadapted program to promote weight loss in 5 NHOPI communities. . Methods-Informant interviews (n=15)and focus groups (n=15, 112 NHOPI participants) were completed to inform the cultural adaptation of the DPP-LI program. A team of 5 community investigators and 1 academic research team collaboratively developed and implemented the 12-week pilot study to assess the effectiveness of the culturally-adapted program.Results-A total of 127 NHOPIs participated in focus groups and informant interviews that resulted in the creation of a significantly modified version of the DPP-LI, entitled the PILI 'Ohana Lifestyle Intervention (POLI). In the pilot study, 239 NHOPIs were enrolled and after 12 weeks (postprogram), mean weight loss was −1.5 kg (95%CI −2.0,−1.0) with 26% of participants losing ≥3% of their baseline weight. Mean weight loss among participants who completed all 8 lessons at 12 weeks was significantly higher (−1.8 kg, 95%CI −2.3, −1.3) than participants who completed less than 8 lessons (−0.70 kg, 95%CI −1.1, −0.29).Conclusion-A fully engaged CBPR approach was successful in translating an evidence based diabetes prevention program into a culturally relevant intervention for NHOPI communities. This pilot study demonstrates that weight loss in high risk minority populations can be achieved over a short period of time using CBPR approaches. KeywordsNative Hawaiian; diabetes mellitus; other Pacific Islander; diabetes prevention; obesity NIH Public Access Author ManuscriptProg Community Health Partnersh. Author manuscript; available in PMC 2010 April 9. Few studies have evaluated the use of CBPR approaches to facilitate the translation of empirically tested programs from clinical trial to community practice. The model of CBPR approach utilized in this pilot project fully embraced the concept and practice of CBPR by involving the community partners in all aspects of the research process from conceptualizing the research question, to conducting the study, to collecting and interpreting the data and to publishing and presenting the results. (22)(23)(24)(25) In this paper, we describe the process undertaken by community and academic researchers of the PILI (Partnerships for Improving Lifestyle Interventions) 'Ohana Project to use CBPR approaches to culturally-adapt the DPP-LI and conduct a pilot study to examine the effectiveness of the modified DPP-LI, called the PILI 'Ohana Lifestyle Intervention (POLI), in NHOPIs communities. The purpose of this paper is to: 1) describe the community-based participatory research (CBPR) process used to culturallyadapt the DPP-LI for NHOPIs; and 2) present results of a pilot study examining the feasibil...
Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the U.S. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research (CBPR) approach. Adult Pacific Islanders (n=144) were randomly assigned to either PLP (n=72) or SBP (n=72), after completing a 3-month weight loss program. Successful weight maintenance was defined as a participants’ post-intervention weight change remaining ≤3% of their pre-intervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p≤0.05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% CI=1.06–24; p=0.02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity-disparities of Pacific Islanders and thus warrants further investigation.
Diabetes prevention requires lifestyle changes, and traditional educational programs for lifestyle changes have had low attendance rates in ethnic populations. This article describes the development and implementation of an educational program, emphasizing retention strategies, cultural tailoring and community participation. Community-based participatory research approaches were used to adapt and test the feasibility of a culturally tailored lifestyle intervention (named Health is Wealth) for Filipino-American adults at risk for diabetes (n = 40) in order to increase program attendance. A unique feature of this program was the flexibility of scheduling the eight classes, and inclusion of activities, foods and proverbs consistent with Filipino culture. We found that with this approach, overall program attendance for the experimental and wait-listed control groups was 88% and participant satisfaction was high with 93% very satisfied. Flexible scheduling, a bilingual facilitator for the classes, and the community-academic partnership contributed to the high attendance for this lifestyle intervention.
The aims of this study were to determine recruitment and retention feasibility, changes in self-efficacy for diet and exercise, and weight and fasting insulin level change after a lifestyle intervention in a community park. A randomized wait-list control design was used to recruit 50 Filipino American participants into a flexible eight-week curriculum. The retention rate was 88%. A weight loss of 1.52 kg (p < .05) and a waist reduction of 5.46 cm (p < .05) were found in the intervention group. Significant predictors for weight loss were gender and marital status. The intervention showed promise for this community program.
Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n=49) or a standard behavior WLP (SBP; n=51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (p≤.05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR=6.04; CI=1.14–32.17) and participants who had more weight loss in the first 3-months (OR=1.47; CI=1.22–1.86) and who were in the PLP (OR=4.50; CI=1.50–15.14) were more likely to achieve ≥3% weight loss [model; χ2 (7, N=100) = 45.50, p < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.
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