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Formative Research to Inform Intervention Development for Diabetes Prevention in the Republic of the Marshall Islands

Injury Research Center at the Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee.

Joel Gittelsohn, PhD

Center and Division of Human Nutrition, Department of International Health, the Johns Hopkins School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland; Center and Division of Human Nutrition, Department of International Health, the Johns Hopkins School of Hygiene and Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205-2179; phone: (410) 955-3927; fax: (410) 955-0196jgittels{at}jhsph.edu

Julia Alfred

Nutrition Unit, the Ministry of Health and Environment, Majuro, Republic of the Marshall Islands.

Neal A. Palafox, MD, MPH

Department of Family Practice and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu.

Formative researchwas conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two main conceptual spheres: foods from the islands/Marshallese foods and imported/American foods. Diabetes (nanimij in tonal) is a highly salient illness and is believed to be caused by foods high in fat and sugar, consumption of imported/American foods, family background, and the atomic bomb testing. Physical activity and eating a traditional diet were viewed as important for preventing diabetes. The traditional belief system links a large body with health, and a thin body with illness; however, perceptions are changing with increased acculturation and education about the health risks of obesity. These findings were used to develop a diabetes prevention home visit intervention currently being implemented and evaluated in Marshallese households.

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