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Journal of Public Health Management & Practice:
Commentary

Empowerment Through Community Building: Diabetes Today in the Pacific

Braun, Kathryn L.; Ichiho, Henry M.; Kuhaulua, Rie L.; Aitaoto, Nia T.; Tsark, JoAnn U.; Spegal, Robert; Lamb, Betty M.

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Abstract

The goal of Diabetes Today, a program of the Centers for Disease Control and Prevention (CDC), is to develop coalitions and train coalition members in assessment, planning, and evaluation to address diabetes in their communities. CDC established the Pacific Diabetes Today Resource Center (PDTRC) in 1998 to tailor the program for Pacific Islander communities in Hawaii, American Samoa, Guam, the Commonwealth of the Northern Marianas Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and Palau. PDTRC's work is guided by the principles of community building and the goal of empowering coalitions to take action around diabetes. Culturally appropriate strategies are used to gain access to the community, transfer knowledge and skills, build coalitions, and provide technical assistance. Evidence of empowerment is seen in increased individual competence, enhanced community capacity, reduced barriers, and improved supports to address diabetes. To maintain the gains of community building in the Pacific, three factors appear critical: an engaged leader, a host agency for the coalition, and continuing access to technical assistance and funds.

In the United States, Native Hawaiians and Pacific Islanders are four to seven times as likely as Caucasians to develop diabetes and are more likely to develop secondary complications from the disease and to die prematurely than are other major racial and ethnic groups.1 The Pacific Diabetes Today Resource Center (PDTRC) was established in 1998 through a contract from the Centers for Disease Control and Prevention (CDC) as a Diabetes Today training center for Pacific Islander communities in Hawaii, American Samoa, Guam, the Commonwealth of the Northern Marianas Islands (CNMI), the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and Palau. Diabetes Today, a program of the Division of Diabetes Translation (DDT) at CDC, aims to enhance the skills of community coalitions to plan, implement, and evaluate their own diabetes prevention and control programs.2

The United States–associated Pacific region includes more than 2,000 small islands and atolls within 4 million square miles of ocean. It takes 12 hours of air travel to cross this vast region–from Hawaii on the eastern edge of the region to Palau on the western edge. Although the jurisdictions have unique cultures and languages, they share a history of colonization and have economic and political relationships with the United States: Hawaii is a state, American Samoa and Guam are U.S.-unincorporated territories, the CNMI is a U.S. commonwealth, and the FSM, RMI, and Palau are independent nations with signed agreements allowing the U.S. military access in return for economic aid.3,4 In addition, Pacific people belong to oral–aural cultures, where face-to-face interactions and hands-on demonstrations are preferred over written or electronic communication.5 Pacific cultures tend to be collectivistic, rather than individualistic, and reciprocity and helpfulness are central to this orientation.6

In the Pacific, increased mortality and morbidity from diabetes are attributed to drastic changes in lifestyle over the past 50 years. Traditional Native Hawaiian and Pacific Islander lifestyles were active, and diets consisted primarily of low-fat, high-fiber foods from the land and sea.7 Today, most islanders have sedentary lifestyles and their diets are high in calories, salt, fat, and refined foods.5 As the incidence and prevalence of chronic diseases (e.g., diabetes) have risen, jurisdictional governments have spent increasingly larger portions of their health budgets on secondary and tertiary care, leaving increasingly limited resources for chronic disease prevention and control.1,5 To help address diabetes prevention and control, DDT policy makers felt that community coalitions could help expand awareness and relevant activities among Native Hawaiians and Pacific Islanders and established PDTRC in 1998.

PDTRC's work is guided by the principles of community building. In community building, agents of change help individuals and communities get involved in, gain skills regarding, and take action about an issue of importance to them.8,9 The desired outcome of community building is empowerment or increased capacity to identify and resolve problems.8–11 We outline the community-building steps used by PDTRC: gaining access to the community,9,12–16 transferring knowledge and skills,13,15 building coalitions,9–12,14,17 and providing technical assistance.15,18,19 We also describe how PDTRC promotes empowerment by helping increase individual's competence, enhance community capacity, reduce barriers, and improve supports for diabetes prevention and control in the Pacific.10,11,17 Factors necessary to maintain the gains of community building in the Pacific are discussed as well.

© 2003 Lippincott Williams & Wilkins, Inc.

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