Diabetes continues to be a growing problem that disproportionately affects minority populations including Native Hawaiians and Pacific Islanders. The Pacific Diabetes Today Resource Center (PDTRC), a program of Papa Ola Lōkahi, was developed in 1999 through a five-year contract with the Center for Disease Control and Prevention’s Division of Diabetes Translation to address the problems of diabetes through community-based interventions in the State of Hawai`i and the six U.S.-associated Pacific-related jurisdictions–the Territory of American Samoa, the Commonwealth of the Northern Mariana Islands, the Territory of Guam, the Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands.
Pacific Diabetes Today Resource Center Objectives: (1) Convene an Advisory Committee with representation from all of the Pacific Jurisdictions and Hawai`i; (2) Revise the Diabetes Today curriculum for the Pacific audience; (3) Conduct Pacific Diabetes Today training in a minimum of 12 communities; (4) Provide technical assistance and resources to those communities that received the training.
The PDTRC established the Advisory Council, which included representatives from Hawai‘i and each of the U.S. Associated Pacific jurisdictions. To begin the development of the Pacific Diabetes Today curriculum, the first year was spent listening to community members and health professionals throughout the Pacific, utilizing discussion groups and key informant interviews. This phase was critical for a) sharing information about this initiative, b) establishing relationships, c) identifying priority issues and concerns of the communities, and d) gaining a better understanding of learning styles and preferences, diabetes awareness levels and knowledge, attitudes and practices regarding diabetes prevention and control.
With the communities’ information and guidance from the Advisory Council members, the PDTRC staff revised the curriculum to build awareness about diabetes in the communities. A “learn by doing” approach was incorporated into the training and attention was given to supporting local co-facilitators and involving a broad range of community members. The curriculum was infused with Pacific themes and graphics provided by Advisory Council members and Pacific Islander colleagues. The curriculum layout was specifically designed to be flexible to accommodate differences in the communities. The modular format allowed community groups to design their own training based on their specific needs.
In the second year, the Pacific Diabetes Today curriculum was pilot tested in five sites. Site selection protocols were developed and implemented. The lessons learned from the pilot sites included: 1) Importance of face-to-face visits for establishing relationships; 2) Translation of the guide with on-site simultaneous translation necessary for some communities; 3) Ownership depended on community planning the training with PDTRC staff; 4) Advisory Committee members need to be involved with training groups, and 5) Importance of Buddy System Training of site coordinators using PDTRC staff to strengthen community capacity.
The training was usually conducted in four stages, depending on the preference of the training organizers. Introduction of the basic planning concepts was followed by hands-on, group exercises. The purpose of the group exercises was to enable participants to apply the planning concepts to better understand and define the problems in their community, and subsequently, propose solutions to the problems. The group exercise sessions also gave participants the opportunity to share ideas and develop action plans to implement diabetes initiatives in their communities.
Support in the form of technical assistance and additional resources in the form of “mini grants” were provided to community groups to facilitate the development and implementation of the diabetes projects they designed during training. Technical assistance was provided to help community groups maintain their momentum, establish collaboration with other community groups, solidify their presence in the community, and expand their influence within the community. All the participating community groups mobilized other individuals and groups to participate in the implementation process.
Years Three – Five:
During 2001through 2003, a total of 12 additional communities were provided with Pacific Diabetes Today training and technical assistance. During the training, each community conducted a community assessment, identified and prioritized the problems, selected a priority issue and developed an implementation plan to address that issue. After the training, technical assistance and resources were provided to assist the community in the implementation of a portion of their community plan.
Over the five year project period, 16 communities were trained utilizing the Pacific Diabetes Today curriculum and one pilot group (Kosrae) was retrained. All 16 groups remain active as of January 2004.