Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai'i Federally Qualified Health Centers: a qualitative descriptive study

OBJECTIVE

The objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for Federally Qualified Health Center (FQHC) patients in Hawai'i, an ethnically diverse state with a high proportion of Native Hawaiians and Pacific Islanders (NHPI).

RESEARCH DESIGN AND METHODS

We used a qualitative descriptive approach. First, we conducted a document review of existing programmatic notes and materials followed by video interview calls with 13 lifestyle coaches at 7 FQHCs implementing in-person LCPs. Lifestyle coaches catalogued, described and explained the rationale for adaptations. The research team counted adaptations if they met a specific adaptation definition derived from several sources. Community and cultural relevancy of adaptations were analysed using an existing framework for weight loss and diabetes prevention for NHPIs.

RESULTS

The average number of adaptations per FQHC was 8.61 (range: 4-16). Adaptations fell into 11 broad categories such as off-site community field trips, food-related and nutrition-related activities, and physical activity opportunities. Novel adaptations included goal setting with motivational interviewing and dyadic recruitment. Field trips and in-class food demonstrations addressed the most constructs related to weight loss and diabetes prevention for NHPI, including social and community barriers, familial barriers and barriers to self-efficacy.

CONCLUSIONS

Lifestyle coaches were culturally attuned to the needs of LCP participants, particularly from NHPI communities. Policy-makers should recognise the extra work that LCP coaches do in order to increase enrollment and retention in these types of programmes.

Assessing Sidewalk and Corridor Walkability in Developing Countries

Finding a simple and less expensive method to assess and improve sidewalk and corridor conditions in developing countries is essential in order to motivate more people to walk. This study aimed to design and test a method that uses direct observations of driver behavior and street measurements to assess sidewalk and corridor walkability in developing countries. The proposed method includes different walkability indicators related to sidewalk features, crossing facilities, sidewalk facilities, and driver behavior to provide one score that represents the walkability of a sidewalk and one that represents the walkability of a corridor. The method was tested on streets from 10 neighborhoods in the city of Doha, Qatar. The results indicated that the developed method was easy to use and could efficiently measure various indicators, illustrating that it can be used to evaluate corridors with different characteristics to identify and rank areas that require improvement. The study’s findings will provide maintenance agencies, policymakers, and practitioners in developing countries with a simple, efficient, and cost-effective method to evaluate, plan, rank, and improve the walkability of sidewalks and corridors.