Abstract
The type 2 diabetes epidemic is a global health issue, and it is especially severe
in the US Pacific. Although there are nutrition interventions in Hawaii and the Pacific,
success is limited, in part, because of the lack of tailoring for the Pacific context.
The Pacific context is inclusive of environment, political, and economic situation;
historical (precontact, colonial, and post colonial) background; cultural practices;
and spiritual orientation. This study used Grounded Theory and Community-Based Participatory
Research 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 United States, 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 influence 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 techniques and
materials by adding family members to motivational interviewing sessions vs patients
only, as Pacific Islanders have a collectivistic culture and family members play an
important role in adherence; conducting motivational interviewing in the community
in addition to the clinical setting; utilizing church leaders as motivational interviewing
counselors in addition to health care providers; and changing motivational interviewing
narratives and tools (eg, 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).
Keywords
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Biography
N. Aitaoto is principal investigator/project director, Manu O Ku Project/Kokua Kalihi Valley, Honolulu, Hawaii.
Biography
S. Campo is an associate professor, Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City.
Biography
L. G. Snetselaar is a professor and chair, Preventive Nutrition Education, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
Biography
K. F. Janz is a professor, Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City.
Biography
E. Parker is a professor and head, Department of Community and Behavioral Health, University of Iowa, Iowa City.
Biography
K. B. Farris is a professor, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor.
Biography
T. Belyeu-Camacho is director, Faith in Action Research and Resource Alliance, Diocese of Chalan Kanoa, Chalan Kanoa, Saipan, Northern Mariana Islands.
Biography
Fr R. P. Jimenez is apostolic administrator, Diocese of Chalan Kanoa, Chalan Kanoa, Saipan, Northern Mariana Islands.
Article info
Publication history
Published online: January 27, 2015
Accepted:
November 19,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was supported by the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), Award No. 1R21MD005975-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH/NIMHD.
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
