Nia Aitaoto MPH, MSPrincipal Investigator, Faith in Action Research Alliance

Advisor , Pacific Chronic Disease CoalitionAdvisor, Pacific Partnership for Tobacco Free Islands

¡ http://upload.wikimedia.org/wikipedia/commons/9/93/Pacific_Culture_Areas.jpg

u Spain u Germany u Japanu USA

Country Per capita income 2005

Percent below PCI 1995

USA $46,000 11.6%Guam $15,000 NACNMI $12,500 33.3%Palau $7,600 62.8%Am Samoa $5,800 67.7%RMI $2,900 NAFSM $2,300 91.0%

Source: Siakvhen Tripod

Per Capita (2006)uUnited States: $5,711uPalau $791uMarshall Islands $471uFSM $270

Source: Earth Trends

Jurisdiction Year Prevalence

Guam 2002-2003 11%

FSM 2002 24%

RMI 2002 30%

Palau 2006 39%

American Samoa 2004 47%

United States 2007 8%

Source: Hosey G, Aitaoto N, Satterfield D, Kelly J, Apaisam CJ, Belyeu-Camacho T,deBrum I, Luces PS, Rengiil A, Turituri P. The culture, community, and science oftype 2 diabetes prevention in the US Associated Pacific Islands. Prev ChronicDis. 2009 Jul;6(3):A104. Epub 2009 Jun 15.

1940’s U.S Navy health surveyu Found: intestinal

parasites, yaws, tuberculosis and skin diseases

u Complete absence of malnutrition or obesity

u No indication of diabetesu Almost no hypertension

Tofa SailiTofa: wisdom Sa’ili: to searchTofa Sa’ili: man reaching out for wisdom,

knowledge, prudence, insight and judgment through reflection, meditation, prayer, dialogue, experiment, practice, performance and observance.

Tui Atua Tupua Tamasese Tai’isi EfiHead of State of Samoa

UNESCO Bio-ethics Conference13 November 2007

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ñ Tofa Mamaoñ Tofa Maninoñ Tofa Loloto

u Holistic Health Approach: Mind, Body and Spiritu If DM is caused by

1. behaviors à shame + lack support à denial à no action*2. God’s will and NOT behavior à passive à no action*3. Pacific disease à fear à action (traditional healers)4. God’s will BUT also disobedience (behavior) à forgiveness +

repentance + support (emotional, spiritual and environmental) àactions

u Actions1. Traditional Medicine2. Local Medicine3. Fad Medicine4. Western Medicine

u Actions àGood Health à Life’s Purpose“Health is NOT the goal is the mean to reach our goal”

Faith in Action Research Alliance Data

u Holistic Health Approach: Mind, Body and Spiritu If DM is caused by

1. behaviors à shame + lack support à denial à no action*2. God’s will and NOT behavior à passiveà no action*3. Pacific disease à fear à action (traditional healers)4. God’s will BUT also disobedience (behavior) à forgiveness + repentance +

support (emotional, spiritual and environmental) à actionu Action

1. Traditional Medicine2. Local Medicine3. Fad Medicine4. Western Medicine

u Action àGood Health à Life’s Purpose“Health is NOT the goal is the mean to reach our goal” Implication: Health communication and motivation

Faith in Action Research Alliance Data

Problem¡ Diabetes Prevalence: 35%

(8% in the US)¡ LEA for T2DM Patients: 18.7

per 1,000 (5.5 per 1,000 in U.S)¡ Barriers:§ Primary Prevention: Chuuk

Road and Improper foot wear

§ Secondary Prevention: Knowledge, Practice and Resources

Federated States of Micronesia: Chuuk State

¡ Increased in foot care knowledge¡ Increased positive attitude towards foot care ¡ Increased practice§ Foot care – nail clipping, filing, etc§ Foot check§ Wound care

2006 2009 % Change

Debridement 31 18 Decreased by 42%

Disarticulation 21 7 Decreased by 67%

Amputation 9 4 Decreased by 56%

“Make educational materials more local!”§ Use local pictures (people we know, community role

models)§ Use local language (not too wordy)§ Make brochures culturally sensitive, relevant to our

culture. For example:▪ Include local foods that are healthy (fish & poi)▪ Show physical activities that attract local people (hula, surfing,

paddling)▪ Use “emotion” – “touch our heart”

§ Pretest! Pretest! Pretest!§ Evaluate! Evaluate! Evaluate!

Lessons Learned: Developing Educational Materials

TOBACCO CONTROL PROGRAM SCHOOLS AND PARENTS

Tobacco QuitlineInformation

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Religio-Cultural Practices and Policies

Most. Rev. Bishop Thomas A. Camacho addresses the health issue of food servings during rosaries held at the church social halls.

¡ 1998-1999 Community Assessmentsñ 11 PDT communities (Hawaii & Pacific)ñ 6 communities (Hawaii, Pacific & continental US)

¡ 1999-2003 Planning and Implementation¡ 2004 Diabetes Today funding ended¡ 2009 Evaluation 11 PDT communities

ñ 9 out 11 PDT coalitions implementing activitiesñ 5 out of 6 coalitions implementing activities

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¡ `Imi Hale & Papa Ola Lokahi¡ Faith in Action Research Alliance (FARA)¡ Pacific Chronic Disease Coalition (PCDC)¡ USAPI Community Based Organizations ¡ Tagata Pasefika