UAMS Intervention Sees Significant Decrease in HbA1c, BMI Levels Among Marshallese Communities
| LITTLE ROCK — Participants in a University of Arkansas for Medical Sciences (UAMS) study to determine the effectiveness of culturally-adapted, family-based diabetes education and management programs for Marshallese families saw significant reductions in HbA1c and BMI (Body Mass Index) levels, according to researchers at the UAMS Institute for Community Health Innovation.
The study examined 185 individuals, including 99 diabetics and 86 family members. Building on research conducted with Marshallese community members in Arkansas, the study was implemented in church settings in Hawaii and Washington state, using trained, bilingual community health workers (CHWs) to administer the family-based Diabetes Self-Management Education and Support (DSMES) program. The program was implemented in partnership with Washington State University and the Hawaii Island Community Health Center.
According to previous studies, more than 90% of Marshallese adults reported regular church attendance.
“Our communities gather regularly at church, and we enjoy surrounding ourselves with other community members,” said Sheldon Riklon, M.D., one of two U.S.-trained Marshallese doctors in the country and a professor at the institute. “We feel comfortable in that setting and are willing to participate as a group or a family there.”
Participants received 10 hours of family-based DSMES education conducted in eight sessions over an eight-to-10-week period. The curriculum covered topics such as healthy eating, physical activity, glucose monitoring, medications, problem-solving, reducing risks, healthy coping and goal setting. The curriculum was also adapted to incorporate cultural norms for Marshallese families, such as adapted recipes and the use of “talk story” — the sharing of stories and experiences — as a way of sharing knowledge and engaging participants.
“Our culture is unique and valuable,” Riklon said. “It’s our identity. If we want to make a significant health impact among Marshallese communities, then cultural norms that are familiar to us are vital and should be incorporated.”
Estimates show that between 20-40% of Marshallese individuals have Type 2 diabetes, compared with 11.6% in the United States and 10.5% worldwide. The institute has also provided outreach and diabetes management programs to Marshallese communities in Arkansas and will work with pharmacies over the next several years to implement DSMES in rural communities across the state.
By the end of the study, diabetic participants saw a 0.69% decrease in their HbA1c levels According to the study, a reduction of HbA1c greater than 0.5% is considered “clinically significant.”
“This study really shows us the value of CHW-delivered health education,” said Pearl McElfish, Ph.D., division director at the institute. “It also shows us the importance of meeting communities where they are, such as church settings, with medical interventions that connect to their cultures.”
For more information about the UAMS Institute for Community Health Innovation, visit communityhealth.uams.edu.
UAMS is the state’s only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; a hospital; a main campus in Little Rock; a Northwest Arkansas regional campus in Fayetteville; a statewide network of regional campuses; and eight institutes: the Winthrop P. Rockefeller Cancer Institute, Jackson T. Stephens Spine & Neurosciences Institute, Harvey & Bernice Jones Eye Institute, Psychiatric Research Institute, Donald W. Reynolds Institute on Aging, Translational Research Institute, Institute for Digital Health & Innovation and the Institute for Community Health Innovation. UAMS includes UAMS Health, a statewide health system that encompasses all of UAMS’ clinical enterprise. UAMS is the only adult Level 1 trauma center in the state. UAMS has 3,485 students, 915 medical residents and fellows, and seven dental residents. It is the state’s largest public employer with more than 11,000 employees, including 1,200 physicians who provide care to patients at UAMS, its regional campuses, Arkansas Children’s, the VA Medical Center and Baptist Health. Visit www.uams.edu or uamshealth.com. Find us on Facebook, X (formerly Twitter), YouTube or Instagram.###