Grant goal: Better education for state's diabetic islanders

An estimated 25 percent to 40 percent of Marshallese adults living in Northwest Arkansas have Type II diabetes, and typical health programs to mitigate the disease are having little success, University of Arkansas for Medical Sciences officials said this week.

Creative solutions are needed to help Marshallese adults manage diabetes. UAMS officials said a $2.1 million grant from the Patient-Centered Outcomes Research Institute awarded to the university July 29 will help structure successful programs.

The grant will be used to identify how diabetes self-management programs can be improved for the Marshallese community, said Pearl McElfish, director of research at UAMS Northwest. McElfish said a partnership with Marshallese in the region has provided UAMS researchers insight into why other programs are failing.

Between 8,000 to 12,000 Marshallese people are estimated to live in Northwest Arkansas, McElfish said. She said the estimate is from information compiled from Marshallese records, local schools and the Arkansas Department of Health.

Marshallese citizens are allowed to travel to the United States without visas after U.S. nuclear-bomb tests on two Marshallese atolls in the 1940s and 1950s. A Compact of Free Association was signed in 1986 by the U.S. government and the Republic of the Marshall Islands allowing for the unrestricted travel.

Arkansas has the largest population of Marshallese on the U.S. mainland and the second-largest population outside of the Republic of the Marshall Islands, according to the Winthrop Rockefeller Foundation. The foundation states that 88 percent of the Marshallese in Arkansas live in Washington County.

McElfish said Pacific islanders have a rate of diabetes 400 percent higher than the general United States population. Eight percent of all adults in the nation are estimated to have Type II diabetes.

Peter Kohler, UAMS Northwest vice chancellor, said it is not fully understood why the Marshallese have a higher rate of diabetes than other populations. He said some theories point back to when the United States government was testing nuclear bombs on the islands.

"After the nuclear fallout contaminated the waters, the U.S. government provided food," Kohler said.

Canned meat such as Spam along with canned fruits and vegetables were staples of the food provided by the government, Kohler said. He added that white rice also was distributed heavily.

"All of those things are less healthy than the fresh fish and unlimited amount of vegetables and fruit they would have had on the islands," Kohler said. He added that diets made up of white rice and canned meat are not healthy for individuals with diabetes.

Kohler said the Marshallese population, including the Northwest Arkansas community, still eat white rice and canned meat.

Research has shown that education about self-management programs for diabetics have not worked very well in the Marshallese community, McElfish said.

Two techniques are typically used to teach diabetics about proper diet and exercise needed to control the disease, McElfish said. The first has the diabetic patient meet with diabetic educators for one-on-one sessions. The other option is for the individual to meet in a group session with other diabetics to learn about self-management.

McElfish said UAMS has held focus groups with the Marshallese community in Northwest Arkansas to try to determine why neither of the typical self-management education techniques have been working.

UAMS researchers discovered that Marshallese family dynamics could be one reason education has not worked in the past, McElfish said.

"They eat out of common pots," McElfish said. "They all eat together and it is shameful if they don't eat what is given to them. We have to convince whoever the food preparer is to give them healthy choices."

Jellesen Rubon-Chutaro has been working with UAMS researchers on the project. She is Marshallese and also a community research coordinator for UAMS.

The family structure in Marshallese families is different from American families, said Jellesen Rubon-Chutaro. She said Marshallese families have traditionally lived together with their adult brothers and sisters. Grandparents also live with the families. That tradition has continued in the United States. Economic reasons also encourage families to live together in one household, she said.

Mealtime is a part of that family structure, Rubon-Chutaro said.

"If you were to come visit me and I offered you something to eat, I won't say, 'Would you like a drink or would you like to eat?"' Rubon-Chutaro said. "I will just make something and bring it to you and if you don't eat it I will think that we are too poor or you don't like what I have."

Funds from the Patient-Centered Outcomes Research Institute grant will be used to educate diabetic Marshallese in their homes with family members present, Kohler said.

"What this grant is intending to do is use the families to help with self-education," Kohler said. "It really brings the whole family into the effort to educate."

NW News on 08/07/2014

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