Validation of the Diabetes Distress Scale in an Asian Pacific Islander Population.

Diabetes distress (DD) generally refers to the emotional and cognitive stress caused by the daily management of diabetes. The Diabetes Distress Scale (DDS)-17 is a 17-item instrument that is frequently used to screen DD and the Fisher's DDS2, developed by Fisher, et al, is a two-item instrument to quickly identify DD. However, these scales have been validated in Caucasian populations but not in Asian Pacific Islander (API) populations. This study aimed to 1) evaluate content validity of the DDS17 by evaluating correlation with hemoglobin A1c and 2) identify two items to develop a brief screening tool, DDS2, for an API population. We conducted a retrospective chart review of 443 patients at a diabetes center in Hawai'i. On their initial visit, patients filled out the DDS17 as a part of the standard of care. The DDS17 showed high reliability (Cronbach's alpha = 0.94). The two items of our DDS2 with the highest phi coefficient (0.59 each) to the total DDS17 subscales were selected from the interpersonal distress and the emotional burden subscales. The phi coefficient (0.74) of our DDS2 was higher than that of the Fisher's DDS2 (0.60). All DDS items showed positive correlation with hemoglobin A1c (DDS17: r = 0.18, DDS2: r = 0.16, Fisher's DDS2: r = 0.21, respectively). Therefore, these scales can be used to measure DD in an API population and the positive correlation suggests that addressing DD may improve glycemic control and vice versa. Clinicians with limited time may consider using our DDS2 rather than DDS17 to quickly screen the API population for DD.

Lifestyle intervention for Filipino Americans at risk for diabetes.

The aims of this study were to determine recruitment and retention feasibility, changes in self-efficacy for diet and exercise, and weight and fasting insulin level change after a lifestyle intervention in a community park. A randomized wait-list control design was used to recruit 50 Filipino American participants into a flexible eight-week curriculum. The retention rate was 88%. A weight loss of 1.52 kg (p < .05) and a waist reduction of 5.46 cm (p < .05) were found in the intervention group. Significant predictors for weight loss were gender and marital status. The intervention showed promise for this community program.

Sociodemographic, behavioral, and biological variables related to weight loss in native Hawaiians and other Pacific Islanders.

OBJECTIVE: Native Hawaiians and other Pacific Islanders (NHs/PIs) have a high obesity prevalence compared to other ethnic groups. We examined socio-demographic, behavioral, and biological factors related to ≥3% weight loss in 100 overweight/obese NHs/PIs who completed a lifestyle intervention. DESIGN AND METHODS: Data were from 56 Native Hawaiians, 22 Chuukese, and 22 Other Pacific Islanders who participated in a randomized controlled trial of the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project. All completed a 3-month weight loss program (WLP) to initiate weight loss and were then randomized into either a 6-month family/community focused WLP called the PILI Lifestyle Program (PLP; n = 49) or a standard behavior WLP (SBP; n = 51). We collected baseline, 3- and 9-month follow-up data on socio-demographics, weight (kg), a 6-min. walk test, dietary fat, exercise frequency, and blood pressure. RESULTS AND CONCLUSION: Based on ANCOVA or logistic fit, ethnicity, sex, initial weight loss, fat in diet at baseline, change in systolic blood pressure, and intervention type were significantly associated (P ≤ .05) with ≥3% weight loss at 9-month follow-up. A logistic regression model indicated that Chuukese (OR = 6.04; CI = 1.14-32.17) and participants who had more weight loss in the first 3-months (OR = 1.47; CI = 1.22-1.86) and who were in the PLP (OR = 4.50; CI = 1.50-15.14) were more likely to achieve ≥3% weight loss [model; χ(2) (7, N = 100) = 45.50, P < .0001]. The same lifestyle intervention does not benefit all NHs/PIs equally, possibly due to differences in acculturation status and social support. The findings also point to the importance of initial weight loss to sustain motivation toward long-term weight loss maintenance.

A review of the literature: evaluating dietary intake of Filipino Americans at risk for type 2 diabetes.

The purpose of this literature review is to investigate the research on the dietary intake of Filipino Americans. Evaluating the dietary practices of Filipino Americans may have an effect on the development of type 2 diabetes. Data collection was obtained, and four databases were included: Pub Medical, Cumulative Index of Nursing and Allied Health Literature, Journals at OVID, and Medline. The key words used in the search were "diet,""type 2 diabetes," and "Filipinos." A total of nine articles were relevant and met the inclusion criteria. The following articles were excluded: studies in a foreign language, letters to the editor, and program descriptions.

Health is wealth: methods to improve attendance in a lifestyle intervention for a largely immigrant Filipino-American sample.

Diabetes prevention requires lifestyle changes, and traditional educational programs for lifestyle changes have had low attendance rates in ethnic populations. This article describes the development and implementation of an educational program, emphasizing retention strategies, cultural tailoring and community participation. Community-based participatory research approaches were used to adapt and test the feasibility of a culturally tailored lifestyle intervention (named Health is Wealth) for Filipino-American adults at risk for diabetes (n = 40) in order to increase program attendance. A unique feature of this program was the flexibility of scheduling the eight classes, and inclusion of activities, foods and proverbs consistent with Filipino culture. We found that with this approach, overall program attendance for the experimental and wait-listed control groups was 88% and participant satisfaction was high with 93% very satisfied. Flexible scheduling, a bilingual facilitator for the classes, and the community-academic partnership contributed to the high attendance for this lifestyle intervention.

A family and community focused lifestyle program prevents weight regain in Pacific Islanders: a pilot randomized controlled trial.

Preventing weight regain after the loss of excess weight is challenging for people, especially for ethnic minorities in the United States. A 6-month weight loss maintenance intervention designed for Pacific Islanders, called the PILI Lifestyle Program (PLP), was compared with a 6-month standard behavioral weight loss maintenance program (SBP) in a pilot randomized controlled trial using a community-based participatory research approach. Adult Pacific Islanders (N = 144) were randomly assigned to either PLP (n = 72) or SBP (n = 72) after completing a 3-month weight loss program. Successful weight maintenance was defined as participants' postintervention weight change remaining ≤ 3% of their preintervention mean weight. Both PLP and SBP participants achieved significant weight loss maintenance (p ≤ .05). Among participants who completed at least half of the prescribed sessions, PLP participants were 5.1-fold (95% confidence interval = 1.06, 24; p = .02) more likely to have maintained their initial weight loss than SBP participants. The pilot PLP shows promise as a lifestyle intervention to address the obesity disparities of Pacific Islanders and thus warrants further investigation.

A center for self-management of chronic illnesses in diverse groups.

Prevention and successful treatment of chronic disease require a scientific understanding of the impacts and interactions of ethnicity, culture, and illness on self-management interventions. This article presents one approach to developing effective methods to address the needs of ethnic minorities living with chronic illnesses. Described is the University of Hawaii Center for Ohana Self-Management of Chronic Illnesses (COSMCI) located in the School of Nursing & Dental Hygiene and funded by the National Institute of Nursing Research (Award Number P20NR010671). The interdisciplinary center focuses on family and community self-management interventions in ethnically diverse populations with chronic illnesses. Areas discussed are: 1) the operational structure for creating an environment conducive to interdisciplinary ohana self-management chronic illness research in ethnically diverse populations; and 2) the development of sustainable interdisciplinary, biobehavioral research capacity. The COSMCI uses a social cognitive theory framework to guide the application of established self-management interventions to Asian and Pacific Island populations (API) through three conceptually linked research projects on HIV infection, type 2 diabetes, and chronic obstructive pulmonary disease. COSMI addresses the feasibility of sharing of lessons learned among the approaches taken. The interdisciplinary nature of COSMCI increases the potential success of the intervention efforts.

Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project.

BACKGROUND: Native Hawaiians (NH) and Other Pacific Islanders (OPI) bear an excess burden of diabetes health disparities. Translation of empirically tested interventions such as the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) offers the potential for reversing these trends. Yet, little is known about how best to translate efficacious interventions into public health practice, particularly among racial/ethnic minority populations. Community-based participatory research (CBPR) is an approach that engages the community in the research process and has recently been proposed as a means to improve the translation of research into community practice. OBJECTIVES: To address diabetes health disparities in NHOPIs, CBPR approaches were used to: (1) culturally adapt the DPP-LI for NHOPI communities; and (2) implement and examine the effectiveness of the culturally-adapted program to promote weight loss in 5 NHOPI communities. METHODS: Informant interviews (n=15) and focus groups (n=15, with 112 NHOPI participants) were completed to inform the cultural adaptation of the DPP-LI program. A team of 5 community investigators and 1 academic research team collaboratively developed and implemented the 12-week pilot study to assess the effectiveness of the culturally adapted program. RESULTS: A total of 127 NHOPIs participated in focus groups and informant interviews that resulted in the creation of a significantly modified version of the DPP-LI, entitled the PILI 'Ohana Lifestyle Intervention (POLI). In the pilot study, 239 NHOPIs were enrolled and after 12 weeks (post-program), mean weight loss was -1.5 kg (95%CI -2.0, -1.0) with 26% of participants losing > or = 3% of their baseline weight. Mean weight loss among participants who completed all 8 lessons at 12 weeks was significantly higher (-1.8 kg, 95%CI -2.3, -1.3) than participants who completed less than 8 lessons (-0.70 kg, 95%CI -1.1, -0.29). CONCLUSION: A fully engaged CBPR approach was successful in translating an evidence based diabetes prevention program into a culturally relevant intervention for NHOPI communities. This pilot study demonstrates that weight loss in high risk minority populations can be achieved over a short period of time using CBPR approaches.

Diabetes bingo: research prioritization with the Filipino community.

This community-based participatory research, conducted in partnership between a European-American academic researcher and a professional group of Filipino nurses, aimed to determine the diabetes research priority for the Filipino community on the island of Oahu in Hawaii, and to evaluate the multi-voting technique to seek input from the community. The study design was a qualitative, cross-sectional interactive process consisting of an educational presentation followed by data collection from the audience. Ten community presentations about the impact of diabetes on the Filipino community were conducted by a Filipino nurse with participants (N=265). Following the educational session, the participants selected priorities for research using a multi-vote technique developed as a Diabetes Bingo card. Community voting results identified prevention and a focus on adults as important priorities for research. Based on the results of the multi-voting, the research partners were able to come to consensus on a research priority area of prevention of type 2 diabetes in adults. Multi-voting using a Diabetes Bingo card, preceded by an educational presentation by a Filipino nurse, was a culturally competent community-based participatory research method that gave voice to the participants and direction to the research partners for future projects. The multi-voting technique was readily accepted and enjoyed by participants.

Partnerships to address obesity disparities in Hawai'i: the PILI 'Ohana Project.

Community-based participatory research (CBPR) is an approach to scientific research that is gaining broader application to address persistent problems in health care disparities and other hypothesis-driven research. However, information on how to form CBPR community-academic partnerships and how to best involve community partners in scientific research is not well-defined. The purpose of this paper is to share the experience of the Partnership for Improving Lifestyle Interventions (PILl) 'Ohana Project in forming a co-equal CBPR community-academic partnership that involved 5 different community partners in a scientific research study to address obesity disparities in Native Hawaiians and other Pacific Peoples (i.e., Samoans, Chuukese, and Filipinos). Specifically, the paper discusses (1) the formation of our community-academic partnership including identification of the research topic; (2) the development of the CBPR infrastructure to foster a sustainable co-equal research environment; and (3) the collaboration in designing a community-based and community-led intervention. The paper concludes with a brief summary of the authors' thoughts about CBPR partnerships from both the academic and community perspectives.