Equitable Diabetes Prevention: Keys to Success from a Pacific Islander Community

This podcast and blog post is presented by the National Nurse-led Care Consortium (NNCC) and describes the unique needs of residents of public housing, underserved racial and ethnic communities, and other special and vulnerable populations and the role community health centers can play in addressing healing and trauma recovery. The below blog post will detail the examples presented in the podcast and provide additional resources for health centers. We speak to Jen Lee from the Association of Asian Pacific Community Health Organization (AAPCHO) and Cecilia Sigrah from Kosrae Community Health Center, located in Kosrae, an island in the Federated States of Micronesia, about the rollout of their Pacific Islander Diabetes Prevention Program (PI-DPP) – now entering its fifth year. Interviewed by Jillian Bird, Director of Training and Technical Assistance at the National Nurse-Led Care Consortium, Jen and Cecilia talk about PI-DPP and the outcomes of providing a tailored prevention program to the communities they serve

The need for Pacific Islander Diabetes Prevention Programs (PI-DPP)

In this episode, our guests describe the diabetes health landscape specific to Pacific Islanders, detail what inspired the creation of PI-DPP, and how it is constantly evolving. Jen walks us through what specifically led to this tailored diabetes prevention program for Pacific Islanders, with the most pressing concern being the rates of diabetes in PI communities. These significant rates of diabetes led to the declaration of a state of emergency in Kosrae. Most interventions mainly focused on management, with a considerable disparity in the prevention of diabetes. People were being diagnosed with diabetes at alarming rates and forced to manage this illness, while primary prevention efforts to lower rates were scarce.

Cecilia highlights the challenges and barriers the PI community faces, attributing to increased diabetes rates, the lack of diabetes management, and the need for more prevention efforts. She explains that the people of Kosrae are employed mainly in sedentary occupations and have difficulty making and attending annual check-ups and meeting the recommended fruit and vegetable intake. Many have been reluctant to make lifestyle changes, believing they will inevitably develop diabetes if a family member has been previously diagnosed. Diabetes prevention programs can debunk these myths and combat family-patterned behaviors to break these cycles.

Creating PI-DPP

The PI-DPP started in 2017 in an effort for more equitable diabetes prevention. Jen shares that the Association of Asian Pacific Community Health Organization (AAPCHO) and the Pacific Islander Center of Primary Care Excellence created this program, considering cultural sensitivity at the organizational and systemic levels. In this regard, cultural sensitivity encompasses competence and awareness in serving communities where they are, working with communities on the ground, and tailoring programs to reflect the people being served. Tailoring programs include using relevant language resources, including the food and diet of the specific region and any culturally responsive images being shown during the program. 

Lifestyle coaches are trained for capacity building by incorporating new data and innovative ways of delivering the program. In creating and evolving this program, AAPCHO continues to rely on partnerships and connections to understand how to best approach this specific framework, the workforce initiative, and sustaining the infrastructure. AAPCHO consults with the Centers for Disease Control and Prevention (CDC) when making changes based on feedback from coaches and member organizations of the PI-DPP as the program evolves. 

Listen at 25:00 to hear Cecilia share examples of partnerships for sustainability.

The evolution and future of PI-DPP

Jen and Cecilia speak on the family-centered approach to the program that engages the next generation. PI-DPP classes are open to the whole family, where the family members can function as a support system. Jen emphasizes the benefits of the family-centered approach and advocates for its use in future interventions. The family-centered approach not only creates a strong support system but raises more awareness of diabetes prevention and management and helps to hold family members accountable to specific diet and exercise standards. If the whole family is involved in the lifestyle change, it may be easier for those at risk for diabetes to change since they are not doing it alone.

Cecilia shares some of the changes over the past five years among individuals in the program and at a community level. Program participants have seen weight loss and improved blood pressure and cholesterol levels at the individual level. These changes are helping to prevent diabetes while also assisting those who make the necessary lifestyle changes to mitigate risk. More residents are starting to recognize the program at the community level and are getting involved. 

Listen from 20:00 to 22:15. Cecilia tells a patient success story

Meet the speakers

Jen Lee is based in Atlanta, Georgia, and is the Deputy Director for the Association of Asian Pacific Community Health Organizations (AAPCHO). Jen has worked in the health center space for about 22 years, starting as a community health worker in one of the AAPCHO member centers. It was during this role that informed perspectives on delivering tailored community-informed care.

AAPCHO was formed in 1987 by community health centers primarily serving medically underserved Asian Americans, Native Hawaiians, and Pacific Islanders. AAPCHO is committed to advocacy, collaboration, and leadership to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders within the United States, its territories, and freely associated states. About 31 community health center members under AAPCHO serve Asian Americans, Native Hawaiians, and Pacific Islanders in the community health center program. AAPCHO has four focus areas: health equity and access, training and capacity building, health care quality and innovation, and COVID-19. 

Cecilia Sigrah is based in Kosrae, an island in the Federated States of Micronesia, and is the Operations Manager, Coordinator, and Lifestyle Coach for the Kosrae Community Health Center. Cecilia comes from a nutritional background and has worked in healthcare for more than 15 years. Cecilia has worked on program planning and implementation of lifestyle change programs. 

Kosrae Community Health Center has three community health centers serving the whole population of Kosrae. The mission is to improve the health of the residents of Kosrae by providing affordable access to comprehensive primary care services. Kosrae Community Health Center focuses on patient-initiated visits and cost-effective activities, including preventative care. Patients have access to medical, dental, behavioral health, and enabling services at each health center site. 

Both organizations have worked closely together over the last five years as part of the rollout of the Pacific Islander Diabetes Prevention Program (PI-DPP).

Additional Resources

Pacific Islander Diabetes Prevention Program Website: https://pacificislanderdpp.org/

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Support for this episode comes from the Health Resources and Services Administration (or HRSA) of the U.S. Department of Health and Human Services (HHS). It is part of an award totaling $550,000 with zero percentage financed with non-governmental sources. The contents of this podcast are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.