Breast-feeding perceptions, beliefs and experiences of Marshallese migrants: an exploratory study

Breastfeeding Intentions among Pregnant Women Enrolled in a Healthy Start Program in Arkansas

INTRODUCTION

Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program.

METHODS

The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program.

RESULTS

The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding.

DISCUSSION

This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods.

Assessing the acceptability and implementation feasibility of a culturally adapted parenting intervention for Marshallese mothers: A study protocol

Background

Pacific Islanders, including the Marshallese, face higher rates of obesity and obesity-related chronic conditions. Early-life interventions targeting eating patterns during the first 1000 days of life are essential to promote proper nutrition and growth. Marshallese mothers and caregivers are important decision-makers for feeding practices that could affect childhood obesity rates in Marshallese children. However, little is known about dietary patterns and practices of Marshallese families from birth to 12 months. Culturally-adapted approaches using community-based assets and Pacific Islander cultural values/practices have demonstrated effectiveness in reducing obesity but have not been developed for children.

Methods

This article describes the protocol for a study to culturally adapt the Centering Parenting intervention for Marshallese mothers in Arkansas.

Conclusion

This will be the first study to culturally adapt and implement Centering Parenting with Marshallese women in the United States. This study will be an important first step to assess the feasibility and acceptability of an abbreviated parenting intervention to reduce childhood obesity in Marshallese communities.

A systematic review of migrant women's experiences of successful exclusive breastfeeding in high-income countries

The World Health Organisation recommends exclusive breastfeeding for the first 6 months after childbirth. However, since breastfeeding is influenced by cultural practice, it differs between migrant mothers and nonmigrant mothers. This systematic review examined migrant mothers' perceptions and experiences impacting achievement of exclusive breastfeeding after immigration from a low-middle-income country to a high-income country. CINAHL, Medline, Scopus, Web of Science, PsycINFO and Emcare were searched for qualitative studies published from 2010 to August 2022. Eleven studies met inclusion criteria. We used meta-ethnographic synthesis to identify overarching themes, resulting in five themes: Migrant mothers (1) 'recognised the differences in breastfeeding practice between their home and host country'. During acculturation, mothers modify or stick to their breastfeeding practice in their host country based on their (2) 'breastfeeding knowledge' by combining their (3) 'original ethnic identity' with the (4) 'influence of family members, healthcare workers, infants, peers and workplace'. Although they face barriers, their (5) 'autonomy' motivated them to continue breastfeeding in a country where the breastfeeding norm differs from where they come from. Intrapersonal and interpersonal socio-ecological factors played a significant role in their breastfeeding practice in the host country. Findings indicate public health policy and practice to support breastfeeding for migrant women in high-income countries can be improved, particularly by emphasising the importance of providing affirmative, comprehensive and practical support from healthcare professionals.

Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population

BACKGROUND

Racial disparities in breastmilk provision and neonatal morbidities of extreme prematurity have been documented in previous studies but are not as well-documented in Asian and Pacific Islander (API) infants. The objectives of this study were to evaluate a predominantly API neonatal intensive care unit (NICU) population for racial disparities in (1) the receipt of breastmilk within 24 h of admission and at discharge and (2) neonatal morbidities among infants ≤ 28 weeks gestational age.

METHODS

A retrospective chart review of 2528 infants from 2018 to 2020 born at the largest level 3 NICU in Honolulu, Hawai'i, was conducted. Multivariable logistic regression analysis was performed on NICU outcomes to calculate adjusted odds ratios (aOR) and confidence intervals (CI).

RESULTS

Native Hawaiian (NH) (aOR 0.73 [0.54, 0.98]), Pacific Islander (PI) (aOR 0.57 [0.41, 0.79]), and Filipino infants (aOR 0.66 [0.49, 0.89]) were less likely to receive breastmilk at discharge compared to Asian infants. PI infants were also more likely to experience necrotizing enterocolitis (aOR 7.89 [1.07, 58.10]) and intraventricular hemorrhage (aOR 3.86 [1.15, 13.02]) compared to Asian infants.

CONCLUSION

In a predominantly API population, disparities in breastmilk receipt and neonatal morbidities exist among NH, PI, and Filipino infants in the NICU. Our findings call for better understanding of the underlying inequities to guide directed efforts, including standardization of care through staff trainings on implicit biases and trauma-informed care, as well as provision of culturally sensitive education and lactation support for these patients.

"It's Okay With Our Culture but We're in a Different Place and We Have to Show Respect": Marshallese Migrants and Exclusive Breastfeeding Initiation

BACKGROUND

Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups.

RESEARCH AIM

To describe infant feeding beliefs and experiences of Marshallese living in the United States.

METHODS

We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants (N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6-8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques.

RESULTS

Participants' mean age was 27.1 years (SD = 6.1), and 88.9% (n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership (n = 28, 77.8%). Most participants had a high school education or lower (n = 30, 83.3%). Mean household size was 7.2 (SD = 2.8). Fewer than half of participants had no health insurance (n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants' infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public.

CONCLUSIONS

Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6-8 weeks postpartum. Findings will inform future health education programs.

Dietary Practices during Pregnancy in a Marshallese Community: A Mixed Methods Analysis

Dietary practices during pregnancy play a pivotal role in the health of women and their children and set the foundation for long-term health. Marshallese women have disproportionally higher rates of maternal and infant health disparities, yet little is known about the dietary practices during their pregnancy. The purpose of this study was to identify dietary practices during pregnancy among Marshallese women. From March 2019 to March 2020, a purposive sample of 33 pregnant Marshallese participants participated in a mixed methods study. Two primary themes emerged: (1) traditional beliefs about a healthy diet during pregnancy; and (2) dietary change during pregnancy. Within the first theme, four subthemes emerged: (1) should eat; (2) should not eat; (3) challenges to traditional diet; and (4) spiritual dietary customs during pregnancy. Within the second theme, three subthemes emerged: (1) a healthy diet for my baby; (2) autonomy and diet; and (3) sugar-sweetened beverages. The transition in discourse from traditional customs of dietary practices to an individualistic discourse highlights that acculturation is a complex process that should be included in maternal health education and interventions. Findings from this study provide insight into potential considerations for future interventions aiming to improve maternal and child health outcomes among Marshallese.

Best of Intentions: Influential Factors in Infant Feeding Intent among Marshallese Pregnant Women

The purpose of this study is to explore the beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding intent among Marshallese pregnant women in the United States (US). The study used a descriptive qualitative design. In total, 36 Marshallese women in their third trimester of pregnancy participated. Participants described exclusive breastfeeding as the preferred method of infant feeding, from both individual and community perspectives. Exclusive breastfeeding was viewed as the healthiest for the infant, viewed as offering protection against sickness, and viewed as better for the overall development of the infant. Of the 36 participants, 28 participants (77.8%) stated that their infant feeding intentions included a hybrid of breastfeeding and formula feeding. The dominant barrier to exclusive breastfeeding was the need to work outside of the home. Unexpected barriers to exclusive breastfeeding were the desire for autonomy and a preference to exclusively breastfeed female infants more than male infants. Exclusive breastfeeding facilitators included support from the Special Supplemental Nutrition Program for Women, Infants, and Children and support and encouragement from female family/community members. This study is the first to document beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding among Marshallese pregnant women residing in the US.

Breastfeeding experiences of Latina migrants living in Spain: a qualitative descriptive study

Background

The migratory flows in Spain have changed due to the arrival of a diverse migrant population. Among the new migrants the Latino collective predominate with more than half being women of childbearing age. There are no previous studies exploring breastfeeding experiences of migrants in a country where their mother tongue is spoken. This study aimed to explore Latina migrants’ breastfeeding experiences in a Spanish-speaking country.

Methods

A descriptive qualitative study was carried out in the main province in southern Andalusia between November 2019 and June 2020. The study used intentional sampling. The study participants were contacted by video calls and data were collected through a semi-structured in-depth interview (n = 19). The interviews were transcribed and analysed by thematic analysis.

Results

The nineteen participants were aged between 22 and 43 years old and came from six different countries in Latin America. The two main categories that emerged were breastfeeding facilitators and barriers, divided into ten interrelated sub-categories: working conditions; precarious socioeconomic conditions; lack of support (health professionals, family and society); physiological changes, pain and fatigue; ignorance and wrong beliefs; support networks (partner, health professionals and family); host country versus home country; religious practices/worship; appropriate attitude, knowledge and experience; and breastfeeding support groups. Most of the study participants stated that their breastfeeding experiences were influenced by barriers such as work and by facilitators such as peer support.

Conclusions

More support from caregivers and more sensitivity to cultural diversity were demanded by the women and well-trained professionals are needed to enable breastfeeding for a longer time. This paper provides caregivers, such as nurses, more knowledge about the care demanded by migrant women to ensure a longer breastfeeding experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00423-y.

A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol

Background

Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas.

Methods

The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers.

Discussion

Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00412-1.

Path Model Validation of Breastfeeding Intention Among Pregnant Women

OBJECTIVE

To validate a blended health belief model and integrated behavioral model of selected modifiable psychosocial constructs during pregnancy to seek the best-fit path model for breastfeeding intention.

DESIGN

A nonexperimental, cross-sectional study.

SETTING

A virtual online market research sample aggregator.

PARTICIPANTS

Women (N = 300) between 18 and 45 years of age in their second or third trimesters of pregnancy participated in the study in February 2018.

METHODS

Based on the health belief model and the integrated behavioral model, we proposed a theoretical framework, including self-efficacy for breastfeeding, knowledge, perceived benefits, perceived barriers, attitude toward breastfeeding, patient-provider interaction, and motivation to breastfeed, to predict breastfeeding intention. We administered a 98-item questionnaire modified from preexisting instruments. We conducted descriptive, bivariate, and regression analyses to help with the formation of the path model.

RESULTS

The best-fit path model with all significant paths and effect directions showed that intention to breastfeed is directly influenced by motivation to breastfeed, attitudes toward breastfeeding, and self-efficacy for breastfeeding, which together accounted for 56% (R²) of the variance in intention. We also identified indirect effects from knowledge about breastfeeding, patient-provider interaction, perceived benefits, and perceived barriers and their interrelationships with effect directions.

CONCLUSION

Through our findings, we contribute to the emerging body of evidence that shows the significant variables and their effect directions for breastfeeding intention. Incorporating these findings may provide support and evidence for clinical and community interventions focusing on modifiable psychosocial constructs during pregnancy to promote breastfeeding and further investigations using health behavior theories.

'Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas

Introduction: Marshallese migrating to the United States encounter challenges in accessing health care. Previous literature has investigated Marshallese participants' perceptions of the barriers they face in accessing health care. For this study, health care providers managing the care of Marshallese patients were interviewed to understand the providers' perception of barriers that their Marshallese patients encounter. Methods: A qualitative research design was utilized to explore health care providers' perceptions of and experiences with the barriers faced by their Marshallese patients when accessing the US health care system. Results: The primary barriers identified were: (1) economic barriers; (2) communication challenges; (3) difficulty understanding and navigating the western health care system; and (4) structural and system barriers. Conclusion: This study provides insight on the barriers Marshallese patients face in accessing health care as well as the barriers providers face in delivering care to Marshallese patients. A better understanding of these barriers can help health care providers and educators to begin initiating improvements in the delivery of care to Marshallese patients.

Documenting and characterising gestational weight gain beliefs and experiences among Marshallese pregnant women in Arkansas: a protocol for a longitudinal mixed-methods study

INTRODUCTION

Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental USA. The Marshallese have higher rates of obesity, type 2 diabetes, pre-term births, low birthweight babies, infant mortality, and inadequate or no prenatal care. Despite the high rates of cardiometabolic and maternal and child health disparities among Marshallese, there are no studies documenting gestational weight gain or perceptions about gestational weight gain among the Marshallese population residing in the USA.

METHODS AND ANALYSIS

This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to understand gestational weight gain in Marshallese women. The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at both first and third trimester, and then augments that data with postpartum data abstraction. Quantitative and qualitative data will be analysed separately and then synthesised during the interpretation phase.

ETHICS AND DISSEMINATION

The study used a community engaged approach approved by the University of Arkansas for Medical Sciences Institutional Review Board (#228023). The research team will disseminate results to study participants, research stakeholders (clinics, faith-based organisations and community-based organisation), the broader Marshallese community and fellow researchers. Results will be disseminated to study participants through a one-page summary that show the aggregated research results using plain language and infographics.

Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review

This scoping review identifies the best practices of community-based participatory research with Pacific Islanders in the United States and United States Affiliated Pacific Islands. Eighty-four articles from January 2000 to December 2017 were included in the review. Best practices included the importance of engaging Pacific Islander community leaders as research staff, community co-investigators, and community advisory board members. Best practices also focused on removing barriers to research by using participants' native languages, conducting research within the geographic community, and spending significant time to build trust. Novel best practices included honoring Pacific Islanders' cultural practices such as protocols for engagement, reciprocity, and social and spiritual inclusiveness and honoring Pacific Islanders' collectivist cultural structure. The goal of this scoping review is to aid community-academic partnerships working to improve the health of Pacific Islanders.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

Effects of providing nursing care with web-based program on maternal self-efficacy and infant health

OBJECTIVE

The study was conducted to examine the efficacy of a web-based program, informed by Pender's Health Promotion Model, given to primiparous women on the growth and development of infant, infants' health, and women's self-efficacy level.

METHODS

This randomized controlled study with a posttest design was conducted in three primary care clinics. The study group comprised 71 primiparous women and their infants (intervention group: N = 35; control group: N = 36). The women who are at the 33-37th gestational week in the intervention group participated in the web-based program. They completed four education modules. Women in the control group received routine care in clinics. Data forms were completed in the first week and first, second, and third months postpartum. Breastfeeding status, weight, head circumference, development of infants and women's self-efficacy were evaluated in the postnatal period up to 3 months.

RESULTS

In the intervention group, the ratio of infants who were exclusively breastfed was higher compared to the control group. The mean scores for the LATCH instrument which measures breastfeeding status and Parental Self-Efficacy Scale, were significantly higher in the intervention compared to the control group (p < .05).

CONCLUSION

The women who participated in the web-based program demonstrated better self-efficacy and their infants demonstrated better scores on measures of growth, development, and health than those in the control group.

Diet, Physical Activity, Obesity, and Breastfeeding: How French People Perceive Factors Associated with Cancer Risk

The French Cancer Barometer, a population-based-survey, is carried out every five years and is, to date, one of the few national studies conducted to investigate individual perception linked to cancer risk factors. The aims of the present study were to describe the perceptions of the French population in 2015 and to assess their evolution over a 5-year period (2010–2015). The French Cancer Barometer surveyed a randomly selected sample of participants aged 15–75 years (n = 3345 in 2010) and 15–85 years (n = 3764 in 2015), representative of the French population. Questions were on perception of diet, physical activity, obesity, and breastfeeding as cancer risk factors. In 2015, nutritional/activity factors were perceived as having an important role in cancer development for the majority of those surveyed (diet (90.8%), obesity (76%), and physical activity (70%)) with the exception being breastfeeding (34%). However, there was a moderate perception of the risks of red meat (43%) and salt or salty food (55%) consumption. Perceptions of nutritional risk factors were mostly associated with age and education level. Interestingly, there was a greater perception of nutritional risk factors in 2015 compared to 2010, and the participants’ opinions were also stronger. Efforts should be made on individuals with lower educational level and to promote the beneficial effects of breastfeeding. However, to impact food behavior, measures are needed at the environmental level and not only at the individual one.

Social and economic influences on infant and child feeding practices in a Marshallese community

OBJECTIVE

The present study aimed to examine the key influences on infant and child feeding practices among a Marshallese community at each social ecological level. It is the first study to examine the key influences on infant and child feeding practices with Marshallese immigrant women in the USA and helps fill a gap in the previous literature that has included other immigrant women.

DESIGN

Community-based participatory research design with twenty-seven participants taking part in four qualitative focus groups.

SETTING

The study took place within the Marshallese community in Arkansas, USA.ParticipantsParticipants included Marshallese women with children aged 1-3 years and/or caregivers. Caregivers were defined as someone other than the parent who cares for children. Caregivers were often older women in the Marshallese community.

RESULTS

There were five primary themes within multiple levels of the Social Ecological Model. At the intrapersonal level, mothers' and caregivers' autonomy emerged. At the interpersonal level, child-led and familial influences emerged. At the organizational level, health-care provider influences emerged; and at the policy level, the Special Supplemental Nutrition Program for Women, Infants, and Children emerged as the most salient influence.

CONCLUSIONS

Marshallese immigrant women's infant and child feeding practices are influenced at intrapersonal, interpersonal, organizational and policy levels. Understanding these multidimensional influences is necessary to inform the creation of culturally tailored interventions to reduce health disparities within the Marshallese community.

Marshallese Beliefs, Perceptions, and Practices Related to Child Feeding Among Marshallese in the United States: Implications for Childhood Obesity

Introduction:

Obesity affects more than 40 million children globally. Efforts to promote proper nutrition in an attempt to reduce childhood obesity should consider maternal beliefs and cultural customs around food. Little is known regarding child feeding, including weaning practices and foods consumed in the first years of life among Marshallese children, a sub-group of Pacific Islanders, residing in the United States.

Methods:

This study aims to explore the influences on introduction of complementary foods among Marshallese mothers and caregivers residing in the United States, to serve as the basis for promotion of improved nutrition. Focus groups and demographic surveys were conducted with Marshallese mothers and caregivers (N = 27) to explore child-feeding beliefs, perceptions, and practices.

Results:

All mothers reported breastfeeding their infants, and 80% reported using some type of milk supplementation. There was a difference in mother and caregiver responses regarding which first foods to introduce and average age of introduction.

Discussion:

Analysis revealed three themes identified as being influential for child-feeding practices: Marshallese breastfeeding customs, introduction of solid foods, and Marshallese family feeding customs.

Intent to Breastfeed and Evaluation of Culturally Sensitive Education in a Migrant Pacific Islander Population

Background

The Marshallese, a Pacific Islander population, are a growing migrant population in the United States. Breastfeeding is the preferred method of infant feeding, but many cultural barriers deter exclusive breastfeeding. A culturally sensitive education intervention was implemented to meet the needs of the Marshallese population in a postpartum setting.

Objective

This study aimed to evaluate the impact of an education intervention, in native language, on breastfeeding rates among Marshallese mothers during hospitalization.

Methods

This quasi-experimental study was a retrospective data analysis of a quality improvement project in a hospital seeking Baby-Friendly status. Randomized record reviews of Marshallese mothers receiving the culturally targeted education (N = 40) between the ages of 18 and 45, delivering between 37 and 42 weeks gestation, were compared with mothers prior to implementation of the education (N = 40).

Results

Birthweight, discharge weight, and delivery method were not statistically different. No statistical difference existed between feeding intent and discharge feeding behavior.

Conclusion

Exclusive breastfeeding rates among Marshallese mothers are lower than desired. Culturally appropriate breastfeeding education in a hospital setting may not affect feeding patterns, but clarification is needed on cultural definitions of exclusive breastfeeding. Further studies are needed.

Using CBPR to address health disparities with the Marshallese community in Arkansas

CONTEXT

Arkansas currently has the largest Marshallese community in the continental US. The limited research available demonstrates that Marshallese have significant health disparities, with higher rates of obesity, diabetes, cardiovascular disease and infectious diseases than the US population.

OBJECTIVES

The purpose of this paper is 2-fold: (1) to describe the formation and capacity building efforts of a community-based participatory research partnership with the Marshallese community in Arkansas and (2) to describe key findings and lessons learned from 5 years of collaborative research.

METHODS

A community-based participatory research approach was implemented to build alliances and improve health disparities in a Marshallese community.

RESULTS

Overarching lessons learned from collaboration with the Marshallese community include the: (1) Intensive involvement of Marshallese from multiple sectors of the community and in multiple roles in the research process, (2) Importance of interprofessional teams, (3) Importance of church, (4) Consideration of sex, (5) Importance of family and definition of family, (6) Talk Story and qualitative methods and the (7) Importance of cultural humility.

CONCLUSIONS

This research helps fill important gaps in documenting the health disparities and interventions to address those disparities in the Marshallese community.

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

BACKGROUND

The Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.

METHODS

Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team.

RESULTS

Four hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.

DISCUSSION

This project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

Leveraging community-based participatory research capacity to recruit Pacific Islanders into a genetics study

Pacific Islanders face many health disparities, including higher rates of cardiovascular disease, cancer, obesity, and diabetes compared to other racial and ethnic groups. Specifically, the Marshallese population suffers disproportionately from type 2 diabetes, with rates 400% higher than the general US population. As part of an ongoing community-based participatory research (CBPR) partnership, 148 participants were recruited for a study examining genetic variants to better understand diabetes. Participants provided a saliva specimen in an Oragene® DNA self-collection kit. Each participant provided approximately 2 mL volume of saliva and was asked qualitative questions about their experience. The study yielded a recruitment rate of 95.5%. Among the 148 persons who participated, 143 (96.6%) agreed to be contacted for future studies; 142 (95.9%) agreed to have their samples used for future IRB-approved studies; and 144 (97.3%) gave permission for the researchers to link information from this study to other studies in which they had participated. Qualitative responses showed that the majority of participants were willing to participate because of their desire to contribute to the health of their community and to understand the genetic influence related to diabetes. This study demonstrates willingness to participate in genetic research among Marshallese living in Arkansas. Willingness was likely enhanced because the feasibility study was part of a larger CBPR effort. This study is important to community stakeholders who have voiced a desire to collaboratively conduct genetic research related to diabetes, perinatal outcomes, and cancer.

Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States

BACKGROUND

Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities-such as the Marshallese-bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D.

OBJECTIVES

Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family.

DESIGN

To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6-8 sessions delivered over a 6-8 week period.

METHODS

The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months.

SUMMARY

The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.