Appendix 1. Partners in Care intervention components and cultural adaptation.
Intervention Components / Partners in CareTheoretical Framework / Social Cognitive Theory
Setting / 2 community health centers, 1 Native Hawaiian Homestead community center
Peer Educators / 2 Native Hawaiian, 1 Filipino; peer educators attended a 1.5 day training to review the study protocol, the topics of each lesson, and practice delivering selected lessons to each other
Stories / Each lesson begins with a short story, related to the topic of the lesson, about a Native Hawaiian grandfather who teaches his grandson about his diabetes self-management activities
Visuals / Native Hawaiians and Pacific People engaging in self-management activities
Foods / Local foods featured in lessons such as poi, laulau, rice, spam, papaya, pineapple, kalua pork
Physical Activities / Local physical activities featured and encouraged in lessons, such as swimming, fishing, playing with family, paddling, surfing, walking, hula
Family and Social Support / Recurring message that healthy eating and physical activity is good for everyone in the family; role playing to increase/improve social support and communication with family members about diabetes; Lessons delivered to small groups of participants to address the physical, psychological, and social challenges of diabetes self-management
Goal Setting, Rewards, Incentives / Emphasized the development of achievable goals; reinforcement of successes achieved; lesson-specific incentives provided to participants
Hands-on Activities and Review / Healthy food demonstrations, demonstration of monofilament test and blood glucose monitoring, participants bring in diabetes medications and received brochures for their specific medications; Jeopardy-type game for review, “sugar” bucks earned for logbook entries of daily blood glucose values
Appendix 1. Partners in Care curriculum lesson topics and content.
Topic / ContentLesson 1: Glucose Balance Makes a Difference / Description and illustrations of what glucose and A1c numbers mean, what are recommended goals for glucose and A1c, and how to lower glucose.
Lesson 2: Medicine and Glucose Balance / Description and brochures for each diabetes medication, possible side effects, brief description of how each medicine works in the body to lower glucose, how to treat hypoglycemia, why it is important to take medication as prescribed, and tell provider about side effects.
Lesson 3: Food and Glucose Balance / How different types of foods may affect glucose, strategies to keep glucose balanced throughout the day
Lesson 4: Plan Meals for Glucose Balance / How to plan healthy meals for glucose balance, how to count carbohydrates, label reading
Lesson 5: Move More, Sit Less! / Focus on increasing physical activity through discussion of challenges to exercise, skills training through role playing, and behavior therapy using goal setting, reinforcement, modeling, and identification of non-food rewards
Lesson 6: Diabetes and a Healthy Heart / Description of how diabetes affects the heart, how to control high blood pressure, recommended goals for blood pressure.
Lesson 7: Diabetes and Cholesterol / Description of total cholesterol, HDL, LDL, and triglycerides, foods that contain which types of cholesterol, how to control high cholesterol, recommended goals for lipids.
Lesson 8: Healthy Feet Keep You Going! / The importance of checking one’s feet every day, how to check one’s feet, getting feet checked by provider, how to identify appropriate shoes to avoid injury to feet, what to do if you have a sore that won’t heal.
Lesson 9: Stress, Depression, and Diabetes / Description of the relationship between diabetes, stress, and depression, how to lower stress, how to know if one is depressed, what to do for depression, 3 stress-reducing strategies practiced.
Lesson 10: Preventing Complications / Discussion of other diabetes-related complications (dental, neuropathy, nephropathy, retinopathy) and how to prevent or delay them.
Lesson 11: Your Diabetes Team / How to better communicate with health care team, who to include in one’s diabetes team, the roles of each person, role playing to practice how to ask questions of providers.
Lesson 12: Living Well with Diabetes / Discussion of relapse prevention strategies to maintain self-management activities to stay healthy with diabetes and prevent/delay complications; during the final lesson, participants had a potluck where they brought in healthy foods to share
Format of Participant Meetings:
1. Participants sign-in
2. Participants receive meeting content to insert into their notebook
3. Healthy snacks and beverages provided
4. Welcome, introduction, and review of previously discussed content
5. Follow-up on goals and discussion of successes and challenges
6. Story read by peer educator
7. Delivery, discussion and activities of lesson
8. Review key points of lesson
9. Participants set goal related to the lesson topic
10. Participants asked to provide anonymous process evaluation feedback
Appendix 1. The story that begins meeting 2 about diabetes medicines.
Before we get started on today’s meeting about diabetes medicines, let’s visit with Kaipo and Uncle Tommy again.
On this day, Uncle Tommy has many
things planned. He has to get an
early start to get all of his chores
done around the house, get to his
appointment at the clinic, and then
he has promised Kaipo that he will
watch him play in a soccer game.
With so much to do, Uncle awoke early, got dressed and went outside. As he watched the sun rise in the east, he thought to himself, “I am a very lucky man to see such a beautiful sunrise.”
A few blocks away, Kaipo was getting
ready for school and thinking about
the game. He knew his Uncle
would be there to watch him.
Uncle never missed a game.
Kaipo couldn’t wait to show Uncle
some of his new soccer moves.
“Mom, can I go have breakfast with
Uncle before I go to school?” Kaipo
asked. “Sure,” his mom said, “but don’t be late for school.”
“Thanks mom,” he said as he grabbed his bag and ran to Uncle Tommy’s house.
“Hi Uncle,” Kaipo said as he gave his Uncle Tommy a big hug. “Just wanted to remind you not to forget the big game today.” Uncle smiled, returning the hug, and said, “You don’t have to worry. I will be there. I have a lot to do today, but I am up early so that I can get them done before the game.”
“How about some breakfast?” Auntie Nani asked Kaipo when she saw him.
He nodded his head and sat down at
the kitchen table. Kaipo watched his
Uncle check his blood sugar and
take his medicine. “Uncle, why
are you taking medicine? Are you sick?”
he asked. Uncle smiled as he answered,
“I'm not sick. I’m taking this medicine to stay
healthy. It is for my diabetes.”
“Remember that I told you that I take care of my
diabetes so I can do things with you that I enjoy so much?” “Yes, Uncle,” said Kaipo as he smiled and remembered what his Uncle had told him when they had gone fishing.
Uncle continued, “Well, the doctor has told me that even though I am doing all I can to take care of my diabetes, that sometimes my body needs help. This medicine helps my blood sugar stay right where I want it. I have made it a habit to take my medicine every morning before I eat, and before I go outside to do my work.”
“You know, Kaipo, this medicine is much like the medicine that we used to gather in the country. It is just in a different form, but it helps me stay well.” Kaipo looked a little puzzled and asked, “You mean they put plants in
pills for us to swallow?” “They
sure do,” Uncle said. “A lot of things
come from the earth and the people that
make the medicine put it into a pill
or shot for us to take. You are going to
learn so much more as you go through
school, so you better get going. I will
see you at the game, okay.”
“Okay, Uncle. The game starts at 4:30, so don’t be late. I know we are going to win the game,”Kaipo said as he ran out the door. Uncle watched as Kaipo left the house, smiled at his wife and thought to himself, “I sure am thankful that there is medicine that helps me feel good.
I love Kaipo and wouldn’t want to miss seeing him grow up. He sure reminds me of myself when I was a boy.” “Well, I guess I better get started if I want to get to the game on time,” Uncle said as he walked out into the yard to begin his work.