Implementation outcomes of a culturally adapted diabetes self-management education intervention for Native Hawaiians and Pacific islanders

• Published in: BMC public health 2020-10, Vol.20 (1), p.1579-11, Article 1579
• Main Authors: Sinclair, Kaʻimi A, Zamora-Kapoor, Anna, Townsend-Ing, Claire, McElfish, Pearl A, Kaholokula, Joseph Keaweʻaimoku
• Format: Article
• Language: English
• Subjects: Clinical trials; Community; Complications; Cultural factors; Culturally adapted; Culturally Competent Care; Curricula; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - prevention & control; Diabetes self-management education; Education; Evidence-based practice; Feasibility; Feedback; Female; Focus Groups; Glucose; Hawaii - epidemiology; Health care; Humans; Implementation outcomes; Implementation research; Intervention; Male; Middle Aged; Native Hawaiian; Native Hawaiian or Other Pacific Islander - education; Pacific Islander; Pacific Islander people; Patient Education as Topic; Peer Group; Pilot Projects; Quality of life; Research methods; Self-Management - education; Sustainability; Teachers
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-09690-6

Native Hawaiians and Pacific Islanders (NHPIs) experience a disproportionate burden of type 2 diabetes and related complications. Although diabetes self-management education and support (DSMES) interventions have generally yielded positive results, few NHPIs have been included in these studies, and even fewer studies have been evaluated using a randomized controlled trial design and/or implementation research methods. The purpose of this pilot study was to evaluate implementation outcomes of a culturally adapted diabetes self-management education intervention delivered by peer educators to Native Hawaiians and Pacific Islanders residing in Honolulu, Hawai'i. In three study sites, the peer educators and 48 participants randomized to the intervention were invited to participate in the mixed methods implementation research. We used a convergent parallel design to collect implementation data including fidelity, feasibility, acceptability, appropriateness, adoption, and sustainability. Data were collected from class observations, participants' class feedback, and post-intervention focus groups with participants and peer educators. In 314 end-of-class feedback surveys, 97% of respondents expressed that they were satisfied or highly satisfied with the class content and activities, 98% reported that the classes and materials were very useful, 94% reported very applicable, and 93% reported materials were culturally appropriate. Respondents identified several aspects of the program as especially enjoyable: interactions with peer educators, meeting in groups, learning about other participants' experiences with diabetes, and the information presented in each class. Major themes that emerged from the end-of-intervention focus groups were the relevance of the educational materials, strategies to manage blood glucose, hands-on activities, cultural aspects of the program, including the stories and analogies used to convey information, and appreciation of the group format and peer educators. Results from this research support a culturally tailored, peer educator approach to DSMES among NHPIs. Delivery of the Partners in Care program is feasible in health care and community settings and is a reimbursable DSMES program. Clinicaltrials.gov Identifier: NCT01093924 prospectively registered 01.20.09.