Faculty Bibliography

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).

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the US Territory of Guam and describes the burdens due to NCD, with an emphasis on diabetes; and assesses the system of service capacity and current activities for service delivery, data collection, and reporting as well as identifying the issues that need to be addressed. There has been an increase of 2.6% in the total population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors are associated with overweight and obesity. The leading causes of death include heart disease, cancer, and cerebrovascular accidents. Population surveys show that 9.1% of the adult population in 2009 reported being diagnosed with diabetes. Other data reports show that of the adults, 35.4% were overweight and 25.9% were obese; and among youth, 30% were overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address NCDs and diabetes. There is no Territory-wide health plan to address the prevention and control of NCDs including diabetes. There are no common standards of care or policy and procedures that are used by all the various medical and health care providers. Based on these findings, priority issues and needs were identified for the administrative and clinical systems.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Yap, and describes the burdens due to diabetes and other NCDs (heart disease, hypertension, stroke, chronic renal disease), and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 1.2% increase in the population between 2000 and 2010; however, there was a significant increase in the 45-64 year old age group. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. The leading causes of death include cancer, heart disease, and diabetes. Local household surveys show that 63% to 80% of the adults and 20.5% to 33.8% of the children were overweight or obese. The surveys also showed that 23% of the adult population had diabetes and 35% were hypertensive. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is a policy and procedure manual that guides the NCD staff. There is no functional data system that is able to identify, register, or track patients with diabetes and other NCDs. Priority administrative and clinical issues were identified.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in American Samoa and describes the burden of selected NCDs (ie, diabetes, heart disease, hypertension, stroke, and chronic kidney disease); and assesses the system of service capacity and activities regarding service delivery, data collection and reporting as well as identifies the issues needing to be addressed. Findings reveal that nutrient-poor diet, lack of physical activity, and other lifestyle behaviors are associated with overweight and obesity and subsequent NCDs that impact the morbidity and mortality of the population. The leading causes of death include heart disease, diabetes, cancer and stroke. Population surveys show that 93% of the adults are overweight or obese and 47% have diabetes. Among public school children, 44.6% are overweight or obese. Other data show that between 2006 and 2010, there was a 33% increase in the number of patients receiving hemodialysis. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is a paucity of health plans, policy and procedure manuals, coordination among providers, and lack of common standards of care. The combined administrative and clinical system of service needs were identified and prioritized. They include the need for a Territory-wide health strategy and plan, need for standards of care, and a need for collaborative team approach for the treatment and management of patients with diabetes and other chronic diseases.

Chronic diseases are among the most costly and, in part, preventable health problems that share common behavioral risk factors. Data related to the prevalence of chronic diseases, such as diabetes, their risk factors, and the description of the capacity of the health and medical care system to address these problems are limited in the US-affiliated Pacific Islands (USAPI). This paper presents the background and methods used in conducting comprehensive assessments of the health care systems in ten sites across the USAPI. The principles used as the basis for conducting these assessments included capacity building and skills training. The methods included identifying the on-site Needs Assessment Team (NAT), developing the conceptual model; archival data collection; key informant interviews; reviewing data and documents to identify the key problems and issues to be prioritized; and reviewing and prioritizing the problems and issues.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Pohnpei and describes the burden due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. Leading causes of death were due to heart disease, diabetes, cancer, and hypertension. Population survey data show that 32.1% of the adult population had diabetes with a higher rate among women (37.1%) when compared to men (26.4%). The data also showed that 73.1% of the adult population was overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no overall planning document for the prevention and control of NCDs or diabetes. There is evidence of little communication among the medical and health care providers which leads to fragmentation of care and loss of continuity of care. Based on some of the findings, priority issues and problems that need to be addressed for the administrative and clinical systems are identified.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Commonwealth of the Northern Mariana Islands (CNMI) and describes the burdens due to NCDs, with an emphasis on diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. There has been a 22.7% decline in the population between 2000 and 2010. Findings of medical and health data reveal that the risk factors of lifestyle behaviors lead to overweight and obesity and subsequent NCD. The leading causes of death are heart disease, stroke and cancer. The 2009 BRFSS survey reveals that the prevalence rate for diabetes was 9.8%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is no overall health plan to address NCDs or diabetes, there is little coordination between the medical care and public health staff, and there is no functional data system to identify, register, and track patients with diabetes. Based on the findings, priority issues and problems to be addressed for the administrative system and clinical system are identified.

Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Chuuk and describes the burdens due to selected NCDs (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 9.2% decline in the total population between 2000 and 2010. Findings of medical and health data reveal that diabetes, myocardial infarction, and septicemia are the leading causes of death and lower limb surgical procedures and amputations was a major problem that was addressed with a foot care education program to prevent amputations. No data were available on the prevalence of diabetes among the population of Chuuk. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is a lack of policy and procedure manuals, coordination among providers, and common standards of care. There is no functional data system to identify and track patients with diabetes and other chronic diseases. Priority issues and problems were identified for the clinical, administrative, and data systems.

Non-communicable diseases (NCD) have been declared a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted on Ebeye Island of Kwajelein Atoll, Republic of the Marshall Islands (RMI) to describe the burdens due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); assess the system of service capacity and activities for service delivery, data collection, and reporting; and identify the key issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that impact the morbidity and mortality of the population. Population survey of the RMI show that 62.5% of the total population is overweight or obese with a dramatic increase from the 15-24 year old (10.6%) and the 25-64 year old (41.9%) age groups. The leading causes of death were septicemia, renal failure, pneumonia, cancer, and myocardial infarction. Other findings show gaps in the system of administrative, clinical, and support services to address these NCD. All health care in Ebeye is provided in one setting and there is collaboration, coordination, and communication among medical and health care providers. The Book of Protocols for the Kwajalein Atoll Health Care Bureau provides the guidelines, standards, and policy and procedures for the screening, diagnosis, and management of diabetes and other NCDs. Based on these findings, priority issues and problems to be addressed for the administrative, clinical, and data systems were identified.