Cultural Translation of Interventions: Diabetes Care in American Samoa

Abstract

Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.Translating efficacious health treatments into routine clinical and public health practice to eliminate health disparities for communities at risk is an increasing public health priority. Recent significant advances in diabetes care have the potential to prevent complications from diabetes and improve quality of life, yet these evidence-based practices are not being used in real-world settings. 1,2 Innovations from other cultures or from efficacy studies in academic settings may be ineffective in low-income, minority, or ethnic communities. This is attributable Correspondence should be sent to Judith DePue, EdD, MPH, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro Bldg 5W, One Hoppin St, Providence, RI 02903 (jdepue@lifespan.org). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsJ. D. DePue originated the overall translation model and intervention and led the writing team. R. K. Rosen originated the qualitative design phases of the study, contributed to writing the sections of the article describing these steps, and contributed to editing throughout. M. Batts-Turner was involved with an earlier study (Project Sugar), advised on translation of protocols and staff training for the current study, and contributed to writing those sections of the article and to editing. N. Bereolos assisted with implementing several phases of the study and contributed to writing lessons learned on study implementation, Step 7 section, and to editing. M.

Does Cultural Adaptation Have a Role in Substance Abuse Treatment?

“…Moreover, the universalist camp cautions that adaptation, a potential threat to intervention fidelity, can decrease program effectiveness. For example, DePue et al (2010), despite developing an effective cultural adaptation methodology, still questioned the extent to which an intervention can be adapted before becoming a different intervention altogether (i.e., throwing out the baby with the bathwater).…”

“…The community participants vary across methods from mental health professionals (Wingood & DiClemente, 2008), community leaders (Domenech Rodriguez & Wieling, 2004) to members of the target group (Wingood & DiClemente, 2008). Some academicians simply confer with the community; however, others form collaborations with the community to adapt the intervention (e.g., DePue et al, 2010; Muñoz & Mendelson, 2005; Podorefsky et al, 2001). Even though the target group can provide a unique perspective about the potential effectiveness of intervention activities, a meta-analysis by Griner and Smith (2006) revealed that members of the target group were rarely included in previous cultural adaptations of interventions.…”

Impact of a diabetes control and management intervention on health care utilization in American Samoa

“…17,18 We found significant improvement in glycosolated hemoglobin (HbA1c) in the CHW group compared with usual care. 18 Adjusted HbA1c among CHW participants was 0.53 units less at the end of the intervention compared with the usual care group, and the odds of reporting a change of at least 0.5% in HBA1c from baseline to end of treatment for the CHW group was 2.07 times greater than among the usual care group.…”

“…21 These flipcharts included eight sections corresponding to the aforementioned diabetes-related behaviors and were adapted to the local context by incorporating cultural features that had been identified through formative focus groups with diabetes patients and in-depth interviews with health care providers. 17 …”

“…Based on prior studies and the design of our intervention 17,18 we hypothesized that those receiving the CHW intervention would show reduced ED visits and hospitalizations, and increased PCP visits during the intervention year, compared to those in the usual care group.…”