Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
BMJ Open. 2020 Nov 4;10(11):e037577. doi: 10.1136/bmjopen-2020-037577.
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).
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.
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.
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.
本定性研究的目的是描述生活方式改变计划 (LCP) 教练在夏威夷为符合联邦合格医疗中心 (FQHC) 条件的患者实施国家糖尿病预防计划课程时所做的社区适宜和文化适宜调整，夏威夷是一个种族多样化的州，其中有很高比例的夏威夷原住民和太平洋岛民（NHPI）。
我们采用了定性描述方法。首先，我们对现有的计划记录和材料进行了文件审查，然后对 7 家实施现场 LCP 的 FQHC 的 13 名生活方式教练进行了视频访谈。生活方式教练对适应情况进行了分类、描述和解释。如果适应情况符合从多个来源得出的特定适应定义，则研究小组将其计数。使用现有的针对 NHPI 的体重减轻和糖尿病预防的框架分析适应的社区和文化相关性。
每个 FQHC 的平均适应次数为 8.61（范围：4-16）。适应情况分为 11 大类，如场外社区实地考察、与食物和营养相关的活动以及体育活动机会。新颖的适应包括使用动机访谈和二元招募进行目标设定。实地考察和课堂食品演示解决了与 NHPI 体重减轻和糖尿病预防最相关的大多数结构问题，包括社会和社区障碍、家庭障碍和自我效能障碍。
生活方式教练对 LCP 参与者的需求具有文化敏感性，尤其是来自 NHPI 社区的参与者。政策制定者应该认识到 LCP 教练在增加这些类型计划的参与率和保留率方面所做的额外工作。
