Our experience suggests that CDSMP can be modified for increased cultural appropriateness for API communities while maintaining the key components responsible for behavior change.

Aims This project tested the six-month impact of Stanford’s Diabetes Self-Management Program (DSMP), adapted for Asians and Pacific Islanders (APIs), on behavioral and clinical indicators. Methods Participants attended DSMP workshops at a community health center. Employing a one-group, pre–post-test design, data were collected at baseline and six-months. Ninety-six eligible API adults were enrolled. All attended four or more of the six weekly sessions, and 82 completed data collection. Measures included body mass index, blood pressure, blood lipids, blood glucose, HbA1c, as well as health behaviors. Data were analyzed by descriptive statistics and paired t-tests. Results Adaptations to DSMP were minimal, but critical to the local acceptance of the program. At six-months, significant behavioral improvements included: (1) increased minutes in stretching and aerobic exercise per week (p < 0.001); (2) reduced symptoms of hypoglycemia and hyperglycemia (p < 0.001); (3) increased self-efficacy (p < 0.001); and (4) increased number of days and times testing blood sugar levels (p < 0.001). Significant clinical improvements included: (1) lower BMI (p < 0.001); (2) lower HbA1c (p < 0.001); (3) lower total cholesterol, triglycerides, and LDL (p < 0.001); and (4) lower blood pressure (p < 0.001). Conclusions Findings suggest that the DSMP can be successfully adapted to API populations and can improve clinical measures as well as health behaviors.

BackgroundDespite evidence of the benefits of regular physical activity, many older adults are not physically active. Health professionals are challenged to replicate evidence-based programs to address low levels of physical activity among members of their communities.Community ContextEnhanceFitness is an evidence-based group exercise program developed in Seattle to increase the strength, flexibility, and balance of older adults. Hawai`i's Healthy Aging Partnership supported the rural island of Kaua`i to select, adapt, implement, and evaluate EnhanceFitness to increase physical activity among older adult residents (75% Asian/Pacific Islander [API]).MethodsEvaluation measures of the replication of EnhanceFitness included fidelity of EnhanceFitness delivery and participants' attendance, satisfaction with the program, confidence to exercise regularly, and pre-post fitness check measures of physical performance (chair stands, arm curls, and the up-and-go test).OutcomesBetween July 2007 and December 2010, 223 Kaua`i residents enrolled in EnhanceFitness; 178 (80%) participated at least 4 months and completed the 4-month fitness checks. EnhanceFitness classes were offered with a high degree of fidelity, and both API and white participants significantly improved their physical performance (chair stands, t = −11.06, P < .001; arm curls, t = −6.66, P < .001; and up-and-go test, t = 6.56, P < .001). Participants reported high satisfaction with the program and instructors and high confidence to continue to exercise regularly.InterpretationEnhanceFitness is replicable in Hawai`i and increased physical performance among API and white older adults. This case study outlines a replication process that other communities can follow.

Health care providers are challenged to replicate evidence-based programs in their communities. These programs may be adapted to fit new communities, but the key components must be delivered with fidelity. This article describes a four-step fidelity assurance protocol developed by the Hawai‘i’s Healthy Aging Partnership as it adapted and replicated evidence-based health promotion programs for Hawai‘i’s older adults. The four steps are the following: (a) deconstruct the program into its components and prepare a step-by-step plan for program replication; (b) identify agencies ready to replicate the program, and sponsor excellent training to local staff who will deliver and coordinate it; (c) monitor the fidelity of program delivery using standardized checklists; and (d) track participant outcomes to assure achievement of expected outcomes. The protocol is illustrated with examples from Hawai‘i’s Healthy Aging Partnership’s experience replicating EnhanceFitness, a senior exercise program. This protocol is transferrable to other communities wanting to adapt and replicate evidence-based, public health programs.

In 2006, funds were received to replicate Stanford’s Chronic Disease Self-Management Program (CDSMP) among eldercare providers in Honolulu. This case study, conducted 1 year after the close of the initial 3-year replication grant, explored factors for sustaining the delivery of CDSMP, with an aim to create guidelines for cultivating sustainability. Face-to-face semi-structured interviews were conducted with one representative from each of eight eldercare agencies, with the representative specified by the agency. Representatives discussed the presence and strength (low, medium, or high) of sustainability factors, including readiness, champions, technical assistance, perceived fit of CDSMP with their agency, CDSMP modifiability, perceived benefits of CDSMP, and other. Only three of the eight agencies (38%) were still offering CDSMP by the end of 2010. Agencies who sustained CDSMP rated higher on all sustainability factors compared to those that did not sustain the program. Additional factors identified by representatives as important were funding and ongoing access to pools of elders from which to recruit program participants. When replicating evidence-based programs, sustainability factors must be consciously nurtured. For example, readiness must be cultivated, multiple champions must be developed, agencies must be helped to modify the program to best fit their clientele, evaluation findings demonstrating program benefit should be shared, and linkages to funding may be needed.