Research indicates that Marshallese (a Pacific Islander population from the Republic of the Marshall Islands) suffer from a significant and disproportionate burden of type 2 diabetes with rates ranging from 24% to 50%.1-4 This is ~400% higher than the general population.1-4 Researchers have noted inadequacies in existing interventions to address the health disparities related to diabetes in Marshallese and other Pacific Islander groups. Current interventions are limited in two ways: 1) interventions are not culturally relevant; and 2) the interventions focus primarily on individual-level motivations that are not likely to be persuasive within the highly collectivistic Pacific Islander cultures.22, 23 Our overall goal is to adapt, test, and disseminate an intervention that is effective at reducing the risk and impact of diabetes among Pacific Islander communities. This application uses a CBPR approach to culturally adapt, implement, and test the Healthy Bodies, Health Souls intervention in Marshallese churches. Healthy Bodies, Healthy Souls is a faith-based intervention originally developed for implementation in African American churches. Health Bodies, Healthy Souls uses a multilevel approach to primary and secondary diabetes prevention. The proposed research builds upon four years of CBPR with Marshallese living in northwest Arkansas.50-54 In phase one of the project, a transdisciplinary CBPR team of university researchers, community co-investigators and the broader Marshallese community will culturally adapt Healthy Bodies, Healthy Souls. The 22-week program addresses diabetes risk at multiple levels by focusing on individual, social, and organizational factors associated with sustained improvements in diet and physical activity. The team will use Bernal's eight dimensions of cultural sensitivity to guide the adaptation process. In phase two, we will implement and test the culturally-adapted program in Marshallese churches. The study will use a mixed-methods approach to evaluate the feasibility, acceptability, and effectiveness of the adapted intervention. We have two specific aims:
Aim 1 : Culturally adapt the Healthy Bodies, Healthy Souls intervention for delivery in Marshallese churches using a community-engaged approach and Bernal's cultural adaptation framework.
Aim 2 : Implement and test the culturally adapted intervention in Marshallese churches using methods of community-engaged research and a mixed methods approach to assess the program's feasibility, acceptability, and effectiveness. The study's findings will add to a very limited scientific knowledge base that informs work with Marshallese and other Pacific Islander communities. The study will generate pilot data to inform other areas with limited research including engaged research with communities that have a history of trauma;59-63 faith-based approaches to diabetes prevention;64 community- engaged cultural adaptation;38, 65-67 and multilevel approaches to diabetes prevention.31-36 The investigative team includes highly qualified academic and community co-investigators with complimentary areas of expertise that have demonstrated success conducting engaged research with Pacific Islanders.
Our overall goal is to adapt, test, and disseminate an intervention that is effective at reducing the risk and impact of diabetes among Pacific Islander communities. This application uses a CBPR approach to culturally adapt, implement, and test the Healthy Bodies, Health Souls intervention in Marshallese churches. The 22- week program addresses diabetes risk at multiple levels by focusing on individual, social, and organizational factors associated with sustained improvements in diet and physical activity.
