Download the audio
Watch on YouTube

The Pacific Islander Diabetes Prevention Program (PI-DPP), is a year-long, evidence-based lifestyle change program recognized and supported by the Center for Disease Control and Prevention (CDC). PI-DPP was formed through a partnership between the Association of Asian Pacific Community Health Organizations (AAPCHO) and the Pacific Islander Center for Primary Care Excellence (PI-CoPCE) as a project funded by the CDC DP17-1705 grant to scale the CDC National DPP in underserved areas. Currently, PI-DPP consists of 11 sites throughout the U.S. and U.S. Affiliated Pacific Islands (USAPI). 

Aligning with DPP success standards, participants aim for 5% body weight loss, 150 weekly physical activity minutes (PAMs), and lower HbA1C values. 

Listen in each week as we highlight PI-DPP sites. Mililani Leui, Program Manager of PI-DPP, sits down with site representatives to hear about their community stories and program impacts. 

This week we spoke with Verna Kyota and Selma August of the Palau Ministry of Health and Human Services (MHHS). MHHS is a government agency providing healthcare services to the Republic of Palau. In this episode, Mililani, Selma, and Verna talk about the importance of support systems for participant retention as well as community-conscious approaches to healthy eating and exercise.

MHHS Lifestyle Coach Group Photo
Photo Courtesy of MHHS

Verna: Alii! My name is Verna Kyota, and I am with the non-communicable disease unit under the Bureau of Public Health, Ministry of Health and Human Services as the diabetes coordinator. At the NCD unit, my main responsibilities are to coordinate diabetes prevention and control activities.

Selma: Hello, my name is Selma August. I work with the NCD Unit, Bureau Public of Health at Palau Ministry of Health. I am currently acting program manager for the NCD, overseeing all the chronic disease programs.

Mililani: Thank you so much Verna and Selma for introducing yourself. My name is Mililani and I am the program manager for the Pacific Islander Diabetes Prevention Program. 

So going into the first question, why is a program like this important for the community you serve?

Selma: A program like this is very important for the Palau community because not all Palauans get their annual check-up, especially those folks who live outside of the main island. The only time they come to the hospital is when they’re sick. This program further enhances our diabetes community awareness education. Conducting this DPP assessment with the participant during the community awareness education, we are able to find and identify participants in the community who are pre-diabetic, and also find those who are diabetic that have not been told by their physician or haven’t been seen.

For Palau, it’s not very easy if we want to change our lifestyles, to better our health when we are doing it alone, especially without [a] support system. Also, Palauans often do not prioritize their own health. They are more concerned about their children and their family’s well-being, even if they are aware of their unhealthy practices. The DPP program gives our community an opportunity to think about their health, and it helps them to take steps in changing their lifestyle through education and health activities. It provides group support that enables people to share the challenges that they face and how they overcome their challenges, which then help others that have the same experience. Our community are more motivated and inspired to change their lifestyle, to become healthier when they do things together rather than doing it alone. The DPP program efforts offers that opportunity to our community towards a longer, happier, and healthier life together.

Mililani: Why is it important to tailor the program to your community’s specific needs?

 Selma: Well, the community in Palau, particularly our culture, is distinct from that in the United States and other countries. Our way of life has been greatly influenced by the still distinctive culture of Palau—our community values, our culture, our language and food and our traditional practice and our sense of belonging. So tailoring the program to the specific needs, makes it more meaningful for them. They are more responsive because they are able to relate the common challenges that they face and are able to support each other in their journey to improve their lifestyle. So, it is important that we modify the program to incorporate some of the Palau culture aspect to get the individual to actually consider their eating patterns or habits, change their actions and alter their attitudes.

Participants participating in a group Zumba class facilitated by MHHS’s DPP
Photo Courtesy of MHHS

Mililani: Is there any background information you would like to share to reinforce the importance of this program for your community?

 Selma: Palau communities have a very limited access to fruits and vegetables. They mostly grow their root crops and rely on fishing as their main source of their food. Also, most of the Palau convenience stores, if not all, do not sell fruits and vegetables. People would have to drive to Koror if they want to purchase items. We seldom see fruits and vegetables. Moreover, people often think that they need facilities, gyms, in order to exercise. But however, they do not see that farming and fishing can be counted for physical activity. The nature that surrounds them offers many ways to do some sort of exercise, whether it is swimming, going to tar patch or fishing, and even house chores like gardening and raking in the yard can be counted, too.

 Mililani: So, what are some of your site’s challenges and or best practices for recruitment, retention and general programming?

Verna: One of our main challenges was the COVID-19 pandemic. As you can imagine, this was a challenging time for the participants as they try to continue their healthy actions and yet, protect themselves and their families from contracting the COVID-19. Another challenge would be our customary practices, which is given. Family meetings and other customary obligations makes it hard for participants to attend sessions, and some eventually drop out of the program. Coaches were also challenged on how they can maintain their classes by coming up with innovative ways to retain participants, while practicing safety measures imposed by the ministry. One way the program had done immediately following the surge was organize a get together celebration, where all participants had come together and shared their challenges and success in their journey. This was a chance for the program to also share progress for each class site through data sharing. It was an ideal way to boost motivation for the participants to continue to build healthier habits and complete the program. So, this is one of the best practices that we would want to keep as we continue to move forward.

MHHS 2019-2022 Impact Report
Photo Courtesy of PI-DPP

Mililani: What impact has your site had on the communities you serve?

Verna: Well, since the program started in 2019, 14 healthcare workers have been certified as lifestyle coaches. Our program has delivered over 200 classes in various states and different community groups. According to our data and the impact report, about 34% of completed program participants have reduced their risk of diabetes and pre-diabetes and other chronic diseases. However, this number is actually higher because participants who were healthy and those who have been diagnosed with diabetes were excluded in the data count. So, that would be much higher than the 34%. We have also established good partnership with several state governments and we continue to maintain and strengthen that relationship to continue our works around primary prevention of diabetes and other chronic diseases.

Mililani: So, what future projects and/or goals does your site have for advancing diabetes prevention and promoting healthy lifestyles?

Selma: In moving forward, we continue to maintain and strengthen our existing partners and identify new ones to maximize resources. We continue to look for training opportunities for the coaches, such as motivational interviews, creating ways to retain participants. We also want to plan to expand the program and reach the outlying states by training the trainers, and we are excited that two of our coaches will be getting trained for the master trainer. Another is to strengthen our community clinical linkages so that we are able to identify people with diabetes and connect them to the clinic and our clinicians to be able to refer patients who are at risk for diabetes and enroll them in the program.

We thank Verna and Selma from the Palau Ministry of Health and Human Services for speaking with us during this week’s segment. Please stay tuned for our next site highlight!

To learn more about the Palau Ministry of Health and Human Services, please visit their website at https://www.palaugov.pw/executive-branch/ministries/health/ and Facebook.

To support MHHS in their pursuit of diabetes prevention and promoting healthy lifestyles, please contact Verna Kyota at verna.kyota@palauhealth.org for more information. 

Facebook: @MHHSPalau