Skip to main content
Patient-Centered Outcomes Research Institute
Patient-Centered Outcomes Research Institute
  • Blog
  • Newsroom
  • Find It Fast
  • Help Center
  • Subscribe
  • Careers
  • Contact Us

PCORI

Patient-Centered Outcomes Research Institute

Search form

  • About Us
    Close mega-menu

    About Us

    • Our Programs
    • Governance
    • Financials and Reports
    • Procurement Opportunities
    • Our Staff
    • Our Vision & Mission
    • Contact Us

    Fact Sheets: Learn More About PCORI

    Download fact sheets about out work, the research we fund, and our programs and initiatives.

    Find It Fast

    Browse through an alphabetical list of frequently accessed and searched terms for information and resources.

    Subscribe to PCORI Email Alerts

    Sign up for weekly emails to stay current on the latest results of our funded projects, and more.

  • Research & Results
    Close mega-menu

    Research & Results

    • Explore Our Portfolio
    • Research Fundamentals
    • Research Results Highlights
    • Putting Evidence to Work
    • Peer Review
    • Evidence Synthesis
    • About Our Research

    Evidence Updates from PCORI-Funded Studies

    These updates capture highlights of findings from systematic reviews and our funded research studies.

    Journal Articles About Our Funded Research

    Browse through a collection of journal publications that provides insights into PCORI-funded work.

    Explore Our Portfolio of Funded Projects

    Find out about projects based on the health conditions they focus on, the state they are in, and if they have results.

  • Topics
    Close mega-menu

    Topics

    • Addressing Disparities
    • Arthritis
    • Asthma
    • Cancer
    • Cardiovascular Disease
    • Children's Health
    • Community Health Workers
    • COVID-19
    • Dementia and Cognitive Impairment
    • Diabetes
    • Kidney Disease
    • Medicaid
    • Men's Health
    • Mental and Behavioral Health
    • Minority Mental Health
    • Multiple Chronic Conditions
    • Multiple Sclerosis
    • Obesity
    • Older Adults' Health
    • Pain Care and Opioids
    • Rare Diseases
    • Rural Health
    • Shared Decision Making
    • Telehealth
    • Transitional Care
    • Veterans Health
    • Women's Health

    Featured Topic: Women's Health

    Learn more about the projects we support on conditions that specifically or more often affect women.

  • Engagement
    Close mega-menu

    Engagement

    • The Value of Engagement
    • Engagement in Health Research Literature Explorer
    • Influencing the Culture of Research
    • Engagement Awards
    • Engagement Resources
    • Engage with Us

    Engagement Tools and Resources for Research

    This searchable peer-to-peer repository includes resources that can inform future work in patient-centered outcomes research.

    Explore Engagement in Health Literature

    This tool enables searching for published articles about engagement in health research.

    Research Fundamentals: A New On-Demand Training

    It enables those new to health research or patient-centered research to learn more about the research process.

  • Funding Opportunities
    Close mega-menu

    Funding Opportunities

    • What & Who We Fund
    • What You Need to Know to Apply
    • Applicant Training
    • Merit Review
    • Awardee Resources
    • Help Center

    PCORI Funding Opportunities

    View and learn about the newly opened funding announcements and the upcoming PFAs in 2021.

    Tips for Submitting a Responsive LOI

    Find out what PCORI looks for in a letter of intent (LOI) along with other helpful tips.

    PCORI Awardee Resources

    These resources can help awardees in complying with the terms and conditions of their contract.

  • Meetings & Events
    Close mega-menu

    Meetings & Events

    • Upcoming
    • Past Events

    January 2021 Board of Governors Meeting

    The Board approved funding for a new research study relating to kidney health and a new funding allocation for PCORnet. Learn more

    Confronting COVID-19: A Webinar Series

    Learn more about the series and access recordings and summary reports of all six sessions.

    2020 PCORI Annual Meeting

    Watch recordings of all sessions, and view titles and descriptions of the posters presented at the virtual meeting.

You are here

  • Research & Results
  • Explore Our Portfolio
  • Developing and Testing a Type 2 Diabe...

This project has results

Developing and Testing a Type 2 Diabetes Education Program Adapted for Marshallese Culture

Sign Up for Updates to This Study  

Results Summary and Professional Abstract

Results Summary

Results Summary

Download Summary Español (pdf) Audio Recording (mp3)

What was the research about?

Type 2 diabetes is a long-term health problem that causes blood sugar levels to rise. It is common among people from the Marshall Islands. Keeping blood sugar levels normal can help prevent damage to the heart, brain, eyes, limbs, and kidneys. Patients can manage diabetes by eating healthy foods, exercising, and checking blood sugar levels regularly.

In this study, the research team worked with Marshallese people living in Arkansas to adapt a diabetes education program. The new program included personal stories and analogies common in Marshallese culture. Patients with type 2 diabetes could invite family members to take part in the education sessions. Patients and family members worked together to set health goals.

The research team compared patients in the new program with those in a standard diabetes education program. The team looked at patients’

  • Blood sugar levels
  • Cholesterol levels
  • Body mass index, or BMI, which measures body fat based on height and weight
  • Diabetes self-care tasks, such as checking blood sugar levels and seeing a doctor

What were the results?

After one year, compared with patients in the standard program, patients in the new program

  • Had lower blood sugar levels
  • Were more likely to check their blood sugar levels regularly

Patients in the two programs didn’t differ in cholesterol levels, BMI, or other diabetes self-care tasks after one year.

Who was in the study?

The study included 221 Marshallese adults with type 2 diabetes living in Arkansas. The average age was 52, and 59 percent were women.

What did the research team do?

The research team worked with Marshallese adults to create the new program. Then the team assigned patients by chance to the new or the standard program. Both programs included 10 hours of diabetes education on topics like healthy eating, exercise, checking blood sugar, and setting health goals.

In the new program, a trained community health worker led eight weekly 75-minute sessions in patients’ homes in the Marshallese language. Community health workers are trained to teach people about health and link people in their community with health and social services. In the standard program, patients went to six weekly 100-minute sessions at a local community center without their family members. A trained diabetes educator gave sessions in English with help from an interpreter.

People from the Marshallese community and healthcare providers were members of the research team.

What were the limits of the study?

The study included Marshallese adults in Arkansas. Results may differ in other places or for people of other backgrounds. The two programs differed in many ways; the research team can’t be sure which parts of the program led to the results.

Future research could test how the new program works for other groups of Pacific Islanders.

How can people use the results?

Health centers that serve Marshallese patients can use these results when considering diabetes education programs.

Professional Abstract

Professional Abstract

Objective

To compare the effectiveness of a culturally adapted, family-centered diabetes self-management education (DSME) program versus standard diabetes education on lowering hemoglobin A1c (HbA1c) levels in Marshallese patients with type 2 diabetes living in Arkansas

Study Design

Design Elements Description
Design Randomized controlled trial
Population 221 Marshallese adults with type 2 diabetes living in Arkansas
Interventions/
Comparators
  • Adapted DSME
  • Standard DSME
Outcomes

Primary: HbA1c levels

Secondary: BMI, total cholesterol, HDL level, diabetes self-care behaviors (glucose monitoring, annual doctor visits, annual foot exam, annual eye exam, maintaining a healthy weight, physical activity)

Timeframe 1-year follow-up for primary outcome

This randomized controlled trial compared the effectiveness of a culturally adapted, family-centered diabetes self-management education program, called adapted DSME, with standard diabetes education, or standard DSME, on lowering HbA1c levels in US Marshallese patients, a population with high type 2 diabetes prevalence.

Researchers randomly assigned patients to either the adapted DSME or standard DSME program. Both programs included 10 hours of diabetes education on topics such as healthy lifestyle habits, blood glucose management, and goal setting. In the adapted program, a trained community health worker delivered eight weekly 75-minute education sessions in patients’ homes in Marshallese. Patients invited one or more adult family members to participate in the sessions with them. Researchers worked with the Marshallese community to create culturally appropriate content for the adapted DSME program. Content included collective goal setting and the use of personal testimonies and analogies common in Pacific Islander culture. In the standard DSME program, patients attended six weekly 100-minute diabetes education sessions at a local community organization without their family members. A certified diabetes educator offered sessions in English with the help of an interpreter.

The study included 221 Marshallese adults with type 2 diabetes living in Arkansas. The average age was 52, and 59% were female.

To measure HbA1c levels, researchers used a rapid A1c test kit. To assess diabetes self-care behaviors, researchers surveyed patients about their glucose monitoring, physical exams, and physical activity. Researchers measured patients’ height and weight to calculate body mass index (BMI), and they used a commercial lipid panel kit to measure total cholesterol and high-density lipoprotein (HDL) levels. Researchers assessed all outcomes at baseline, immediately after the intervention, and again 6 and 12 months after the intervention.

The Marshallese community, healthcare providers, and researchers used a community-based participatory research approach to design the study and collect data.

Results

After one year, compared with patients in the standard DSME program, patients in the adapted DSME program had greater declines in HbA1c levels (p=0.013).

Patients in the adapted DSME program were also more likely to check their blood glucose levels regularly compared with those in the standard DSME program (p<0.05).

Patients in the two programs did not differ in BMI, total cholesterol, HDL, or other diabetes self-care behaviors after one year.

Limitations

The study included Marshallese patients in Arkansas. Findings may not be generalizable to other geographic regions or populations, including Marshallese patients living outside of Arkansas. The adapted DSME program differed from the standard DSME program in several ways; researchers cannot be sure which aspects of the adapted DSME program affected which outcomes.

Conclusions and Relevance

In this study, a culturally adapted education program offered in patients’ homes and involving family members improved blood glucose levels for Marshallese patients with type 2 diabetes.

Future Research Needs

Future research could test whether the adapted DSME program is effective among other groups of Pacific Islanders.

Final Research Report

View this project's final research report.

Journal Articles

Results of This Project

Diabetes Care

Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial.

Related Articles

Families, Systems & Health

Effects of a family diabetes self-management education intervention on the patients' supporters

Contemporary Clinical Trials Communications

"The results are encouragements to make positive changes to be healthier:" Qualitative evaluationof Marshallese participants' perceptions when receiving study results in a randomized control trial

Journal of Primary Care & Community Health

Pilot Implementation of Adapted-Family Diabetes Self-Management Education Into a Clinical Setting

Diabetic Medicine

Diabetes self-management education exposure and glycated haemoglobin levels among Marshallese participants in a randomized controlled study

American Journal of Health Behavior

The Effect of Family Diabetes Self-management Education on Self-care Behaviors of Marshallese Adults with Type 2 Diabetes

Diabetes Care

Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial

Current Diabetes Reports

Diabetes Disparities and Promising Interventions to Address Diabetes in Native Hawaiian and Pacific Islander Populations

Annals of Human Biology

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

Progress In Community Health Partnerships

Cultural Adaptation of Diabetes Self-Management Education for Marshallese Residing in the United States: Lessons Learned in Curriculum Development

Nursing Inquiry

Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific Islander community

Contemporary Clinical Trials Communications

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

International Journal of Nursing & Clinical Practices

A Social Ecological and Community-Engaged Perspective for Addressing Health Disparities Among Marshallese in Arkansas

Diabetes Education

Family Model of Diabetes Education With a Pacific Islander Community

More on this Project  

PCORI Stories

Empowering the Marshallese Community in Managing Type 2 Diabetes
Type 2 diabetes has become a well-known part of daily life for the Marshallese community. In Northwest Arkansas, health screenings found 38.4 percent of Marshallese people with hemoglobin A1c (HbA1c) levels indicating diabetes. Read about this study, which found that Marshallese adults in a culturally adapted diabetes education program experienced significantly greater reductions in hemoglobin A1c after one year in the program, compared with adults in a standard program.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers asked whether the researchers based their hypothesis on the limitations of previous research in this population, or on evidence that a family-based approach to diabetes care was successful in other communities. The researchers added this discussion to the report, stating that they developed their hypothesis and intervention based on their own pilot work, the limitations of other studies, input from stakeholders, and success of other family-care models.
  • Reviewers noted that the two interventions tested differed in several ways that included but were not limited to the family component.  They also stated that the trial did not allow for the possibility of attributing any observed differences in results to any particular component of each intervention. The researchers agreed that the original name of one of the two diabetes self-management education (DSME) interventions “Family DSME,” did not fully capture the extent of the differences that the intervention offered compared to Standard DSME. They changed the name of Family DSME to Adapted DSME in response to this concern.
  • Reviewers asked that the report describe the clinical importance of any observed differences in results and not overinterpret small differences. The researchers edited the report to soften the language and offer more context in describing differences observed between the two study arms.

Conflict of Interest Disclosures

View the COI disclosure form.

Project Details

Principal Investigator
Peter O. Kohler, MD
Project Status
Completed; PCORI Public and Professional Abstracts, and Final Research Report Posted
Project Title
Extended Family Model of DSME to Reduce Disparities in a US Pacific Islander Community
Board Approval Date
July 2014
Project End Date
May 2019
Organization
University of Arkansas for Medical Sciences
Year Awarded
2014
State
Arkansas
Year Completed
2019
Project Type
Research Project
Health Conditions  
Nutritional and Metabolic Disorders
Diabetes
Intervention Strategies
Behavioral Interventions
Other Health Services Interventions
Training and Education Interventions
Populations
Individuals with Multiple Chronic/co-morbid Conditions
Low Health Literacy/Numeracy
Low Income
Racial/Ethnic Minorities
Rural
Funding Announcement
Addressing Disparities
Project Budget
$2,163,228
DOI - Digital Object Identifier
10.25302/04.2020.AD.131007159
Study Registration Information
HSRP20152031
NCT02407132
Page Last Updated: 
September 28, 2020

About Us

  • Our Programs
  • Governance
  • Financials and Reports
  • Procurement Opportunities
  • Our Staff
  • Our Vision & Mission
  • Contact Us

Research & Results

  • Explore Our Portfolio
  • Research Fundamentals
  • Research Results Highlights
  • Putting Evidence to Work
  • Peer Review
  • Evidence Synthesis
  • About Our Research

Engagement

  • The Value of Engagement
  • Engagement in Health Research Literature Explorer
  • Influencing the Culture of Research
  • Engagement Awards
  • Engagement Resources
  • Engage with Us

Funding Opportunities

  • What & Who We Fund
  • What You Need to Know to Apply
  • Applicant Training
  • Merit Review
  • Awardee Resources
  • Help Center

Meetings & Events

January 21
Cycle 1 2021 Broad PFA Applicant Town Hall
February 2
PCORI 2021 and Beyond: Opportunities for Funding and Involvement in Patient-Centered Research
February 9
Board of Governors Meeting: February 9, 2021

PCORI

Footer contact address

Patient-Centered Outcomes
Research Institute

1828 L Street, NW, Suite 900
Washington, DC 20036
Phone: (202) 827-7700 | Fax: (202) 355-9558
[email protected]

Subscribe to Newsletter

Twitter Facebook LinkedIn Vimeo

© 2011-2021 Patient-Centered Outcomes Research Institute. All Rights Reserved.

Privacy Policy | Terms of Use | Trademark Usage Guidelines | Credits | Help Center