UAMS has implemented a family-centered diabetes self-management education and support program designed to suit the cultural values of the Marshall community.
Fayetteville, Arkansas – Health professionals are tackling the Marshall community's health crisis (type 2 diabetes) through innovative initiatives led by the University of Arkansas Medical Sciences (UAM).
Recent research by UAMS Assessment of a culturally adapted, family-based diabetes education programme, participants experienced reductions in both hemoglobin A1C (HBA1C) and body mass index (BMI).
Community-driven approach
From the Marshall Islands to Hawaii and now Arkansas, community advocate Romaldo Con Kabua is dedicated to addressing Marshall's population disparities.
“As a Marshaller, I have always loved helping people, especially my community, to deal with the gaps we face. That's where I plug in and fit into the gap. It's about seeing if you can,” Kabua said.
Kabua is part of a team led by Dr. Pearl McCarfish and Dr. Sheldon Likron, who studied 185 participants, including 99 diabetes patients and 86 families. Their research aimed to find the root causes of community health issues. According to Mcelfish, the historical dietary changes caused by nuclear tests in the Marshall Islands, which destroyed traditional food sources, have contributed to this issue.
“Unfortunately, the food that was shipped was high in sugar, simple carbohydrates, fats, and lots of spam, white rice and sweet drinks,” McFalish said.
UAMS has implemented a Family-centered Diabetes Self-Management Education and Support (DSMES) program designed to match the cultural values of Marshall's community. The programme incorporated family involvement, traditional recipes, team sports and church activities to create a support environment for participants.
The curriculum, provided in eight sessions over 8-10 weeks, covered topics such as healthy diet, physical activity, glucose monitoring, and coping strategies. It also featured a “talk stories,” a traditional way of sharing experience and knowledge.
By the end of the study, diabetic participants achieved a 0.69% reduction in HBA1C levels (clinically significant improvement), as well as a decrease in BMI.
“This study really shows the value of health education delivered by CHW,” says Mcelfish. “It also shows us the importance of meeting the community they have, such as the church environment, with medical interventions that lead to their culture.”
The church, the heart of Marshall's life, served as an important venue for the program. Over 90% of Marshall adults report regular church attendance. The importance of the Likron Church goes beyond the practice of faith for those in the Marshall community.
“Our community enjoys meeting regularly at churches and surrounding themselves with other community members,” Likron said. “We feel comfortable in that environment and are willing to participate in it as a group or family there.”
The success of the program has encouraged its expansion across northwest Arkansas to the Marshall community in Washington and even the Marshall community in the Marshall Islands. UAMS will work with pharmacies in the coming years to implement the DSMES program in rural Arkansas.
According to UAMS, the rate of diabetes in Marshall's individuals is estimated between 20% and 40%, but 11.6% in the US and 10.5% worldwide.
“Our culture is unique and valuable,” Likron said. “That's our identity. If we want to have a significant health impact among our Marshall community, the cultural norms familiar to us are essential and should be incorporated.”
Visit UAMS Institute for Community Health Innovation and its programs communityhealth.uams.edu.
