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The type 2 diabetes (T2DM) epidemic is a global health issue that is especially severe among Pacific Islanders in the United States (U.S.) and U.S. Associated Pacific Islands (USAPI) including Chuukese living in their homeland of Chuuk and the state of Hawaii. Although there are diabetes prevention and management programs in Hawai'i and the Pacific, success is limited due in part to the lack of tailoring for the Pacific audience. In spite of numerous recommendations to incorporate Pacific cultural constructs into health interventions, there are no studies in Chuuk or the Pacific that examine the integration of cultural constructs into diabetes prevention and management. To address this research need, the four studies in this dissertation used Grounded Theory and Community Based Participatory Research (CBPR) processes to explore the relationships between constructs such as culture, religion, family, and diabetes prevention and control. The aims were to obtain perspectives on diabetes prevention, screening and management (Study1) and identify socio-cultural influences that hinder or facilitate adherence to diabetes prevention and management behaviors specifically adherence to nutrition therapy (Study 2), physical activity (Study 3) and prescription medication (Study 4). Data where gathered through key informant interviews (faith leaders and health care providers) and focus group discussions (individual with diabetes and care takers).
Results from Study 1 showed that participants perceived T2DM as a major problem and the discussion followed four significant narratives: (1) the need for specific information on "how to" operationalize diabetes treatment recommendations; (2) the practice of seeking medical help only when in pain; (3) the role spirituality plays in etiology disease beliefs and its influence on help-seeking behaviors; and (4) the role emotions play in treatment compliance. Study 2 revealed barriers to nutrition therapy adherence that were similar to other minority populations in the U.S. 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 nutrition modification options. It also elucidated: (1) food consumption and preparation practices; (2) the need for culturally tailored interventions; and (3) contextually appropriate approaches to address nutrition issues, including a plan for future research and interventions. Study 3 revealed a variety of behaviors, personal factors and environmental influences related to adherence to physical activity recommendations. Although the study was focused on physical activity, participants spent the majority of their time discussing sedentary behaviors and contextually appropriate interventions. Study 4 exposed vital factors that inclined patients' to comply with prescribed medication. Factors associated with the healer (messenger), medicine/remedy, and focus of healing. Furthermore, this study revealed that many patients not only seek multiple healing types (western, traditional, local and new), they also rotate among the types. These findings were communicated through two narratives: healer characteristics and medication-specific features. Overall, the most salient topics in all the focus group and interview discussions were on diabetes as a major problem and the pervasiveness of hopelessness. Woven into these conversations were narratives on how to address these two issues with stewardships of the spirit, mind and body. This became the foundation of a framework to address the diabetes epidemic in Pacific.