As type 2 diabetes prevalence increases in the United States, the burden of diabetes falls more on groups with greater barriers to care, such as language and cultural differences, and lower economic resources. Healthy People 2010 targeted diabetes as one of six diseases for the elimination of racial and ethnic health disparities. These disparities extend to the US Territory of American Samoa, where the proportion of adults >18 years with diabetes was 19.6% in 2002, compared to 6.4% of US adults. There have been no reported diabetes interventions in Samoans in the US. The overall purpose of this application is to translate recent advances in diabetes care into clinical practice for the American Samoan community by improving methods of health care delivery and improve methods of diabetes self management. We will use the community health worker model to test an expanded diabetes care model. Community health workers (CHW) have frequently been used to serve as """"""""bridges"""""""" between health care services and patients in poor ethnic minority communities. CHW workers provide culturally appropriate health education and instrumental social support and facilitation, and even organization, of access to care, while also providing patient information to medical providers. We propose a clinical trial to test the effectiveness of a CHW and primary-care coordinated intervention to provide outreach, education and support to 352 type 2 diabetes patients and their families in American Samoa. The outcomes at a one-year follow-up will include glycosolated hemoglobin (HbA1c), cardiovascular disease risk factors, diet and exercise behaviors, and adherence to diabetes care guidelines. The intervention builds upon best clinical practices for diabetes care by translating effective strategies to American Samoans. The translation of good diabetes care there may offer a model that is potentially replicable in other ethnic minority populations suffering the burden of diabetes.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Demonstration and Dissemination Projects (R18)
Project #
Application #
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (M1))
Program Officer
Staten, Myrlene A
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Brown University
Public Health & Prev Medicine
Schools of Medicine
United States
Zip Code
Daiello, Lori A; Gongvatana, Assawin; Dunsiger, Shira et al. (2015) Association of fish oil supplement use with preservation of brain volume and cognitive function. Alzheimers Dement 11:226-35
Hawley, Nicola L; Johnson, William; Hart, Chantelle N et al. (2015) Gestational weight gain among American Samoan women and its impact on delivery and infant outcomes. BMC Pregnancy Childbirth 15:10
Rao, Mayuree; DePue, Judith D; Dunsiger, Shira et al. (2015) Long-Term Impact of a Community Health Worker Intervention on Diabetes Control in American Samoa. Prev Chronic Dis 12:E180
Hawley, Nicola L; Brown, Carolyn; Nu'usolia, Ofeira et al. (2014) Barriers to adequate prenatal care utilization in American Samoa. Matern Child Health J 18:2284-92
Hamid, Sarah; Dunsiger, Shira; Seiden, Andrew et al. (2014) Impact of a diabetes control and management intervention on health care utilization in American Samoa. Chronic Illn 10:122-34
Hawley, N L; Johnson, W; Nu'usolia, O et al. (2014) The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants. Pediatr Obes 9:e1-e13
DePue, Judith D; Rosen, Rochelle K; Seiden, Andrew et al. (2013) Implementation of a culturally tailored diabetes intervention with community health workers in American Samoa. Diabetes Educ 39:761-71
DePue, Judith D; Dunsiger, Shira; Seiden, Andrew D et al. (2013) Nurse-community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial. Diabetes Care 36:1947-53
Stewart, Diana W; Depue, Judith; Rosen, Rochelle K et al. (2013) Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry. Transl Behav Med 3:30-38
Lambert-Messerlian, G; Roberts, M B; Urlacher, S S et al. (2011) First assessment of menstrual cycle function and reproductive endocrine status in Samoan women. Hum Reprod 26:2518-24

Showing the most recent 10 out of 14 publications