Formative Research to Inform Nutrition Interventions in Chuuk and the US Pacific

Abstract

The type 2 diabetes epidemic is a global health issue, and it is especially severe in the U.S. Pacific. Although there are nutrition interventions in Hawai’i and the Pacific, success is limited due in part to the lack of tailoring for the Pacific context. The Pacific context is inclusive of environment, political and economic situation; historical (pre-contact, colonial and post-colonial) background; cultural practices; and spiritual orientation. This study used Grounded Theory and Community Based Participatory Research (CBPR) processes to identify influences that hinder or facilitate adherence to nutrition recommendations. Data were gathered through key informant interviews (faith leaders and health care providers) and focus group discussions (individual with diabetes and care takers). Results showed barriers to nutrition recommendations adherence that were similar to other minority populations in the U.S. such as cost of healthy foods, taste preference, low availability of healthy food choices, lack of ideas for healthy meals/cooking, and lack of culturally appropriate options for dietary modification. It also elucidated behaviors that influences adherence to nutrition recommendations such as preparing and consuming meals for and with extended family and church members; patient and group motivation; and access to healthy, affordable and palatable foods. Participants expressed the need for interventions that are tailored to the local culture and context and a holistic view of health with a focus on motivation (spiritual and emotional support). These findings could be used to develop culturally and contextually appropriate programs. For example, adapting Motivational Interviewing (MI) techniques and materials by adding family members to MI sessions versus patients only as Pacific Islanders have a collectivistic culture and family members play an important role in adherence; conducting MI in the community in addition to the clinical setting; utilizing church leaders as MI counselors in addition to healthcare providers; and changing MI narratives and tools (e.g., a confidence scale of 1 to 10 will be unfamiliar to many Pacific Islanders, therefore, counselors need to develop another method to indicate levels of confidence, such as the color of the lagoon/ocean that goes from turquoise [the color of shallow water] to navy blue [the color of deep water].

Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders

“…Researchers often define “community” by race/ethnicity, religious or sexual orientation, acculturation and socioeconomic status, and geographic locale. CBPR has been used extensively as a research approach with NHPI communities to address a range of infectious and chronic diseases (Nacapoy et al 2008; Braun, Allison, and Tsark 2008; Dela Cruz et al 2016; Chung-Do et al 2016; Aitaoto et al 2015). …”

Effectiveness of a Lifestyle Intervention in Patients with Type 2 Diabetes: The Physical Activity and Nutrition for Diabetes in Alberta (PANDA) Trial

“…Thus, not surprisingly, type 2 diabetes (T2D) patients have poor adherence to dietary recommendations [7,8]. Personal factors that may be barriers to adherence include language and communication skills, lack of knowledge or motivation, taste preferences and cravings, cooking skills, and lack of family and social support [9,10]. Acculturation, lack of cultural acceptability of recommended diets and the cost of recommended foods are also barriers to diabetic diet adherence [10,11].…”

“…Personal factors that may be barriers to adherence include language and communication skills, lack of knowledge or motivation, taste preferences and cravings, cooking skills, and lack of family and social support [9,10]. Acculturation, lack of cultural acceptability of recommended diets and the cost of recommended foods are also barriers to diabetic diet adherence [10,11]. Diabetes educators recognize that clients’ ability to incorporate recommendations is affected by these factors but that many clients may not have strategies and tools to overcome these barriers [12].…”

Leveraging Cultural Knowledge to Improve Diet and Health among Affiliated Pacific Islander Populations

“…4 Nearly one-third of all Samoans live in the United States, and of these 60% reside in Hawaii and California. 27 Given that Aitaoto and colleagues 4 needed to gather data from Chuuk adults residing in Hawaii, as well as residents in Chuuk, the same migration trend appears to be occurring as is occurring among the Samoan peoples.…”

“…3 This lack of information regarding the populations of USAPI jurisdictions was the motivation for the work reported in this month's Journal by Aitaoto and colleagues. 4 This research editorial highlights the value of the methods used and their potential to support positive outcomes, provide complementary information from research activities among the USAPI populations, and the research gaps. We also discuss the importance of continued research to provide the foundation for evidence-based guidance for Pacific populations, which comprise more than 1.2 million people living in the United States and are represented in every state.…”