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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, chats with site representatives to hear about their community stories and program impacts.
This week, we spoke with Libon Jorkan and Tanner Smith of Majuro Wellness Center (MWC). MWC is located in Majuro, the capital of the Republic of the Marshall Islands (RMI). MWC is led by the non-profit organization, Canvasback Missions. In this episode, Libon, Tanner, and Mililani talk about the importance of community conversation and cultural competency in PI-DPP as well as innovative retention strategies.
Photo courtesy of MWC
MWC Staff Group Photo
Libon: My name is Libon Jorkan, and I am a lifestyle coach and also a site coordinator.
Tanner: My name’s Tanner Smith. I’m the regional director for Canvasback Wellness Center.
Mililani: My name is Mililani and I am the program manager for the Pacific Islander Diabetes Prevention Program.
The first question is, why is a program like this important for the community you serve?
Libon: There’s a lot of reason for that, but I would say the main reason why it’s important for the community is to give them a really good understanding of what diabetes is and how they can prevent themselves from getting it.
Tanner: For me, I think it’s important because it’s something that the people aren’t really hearing a lot about or really talked about in the community is pre-diabetes issues. In the past, it’s either been, “Okay, I’m diabetic.” Or, “I’m not diabetic.” This gives them kind of a warning to, “Hey, you’re going towards diabetes, and we need to fix that now.” So it’s a nice way to get them to turn things around before they get into that diabetic state.
Mililani: Why is it important to tailor the program to your community’s specific needs?
Tanner: Why is it important to tailor the program? Each community, even take the example of Majuro itself has its own different dynamics to it. We’ve started in one community and did the program at a certain location or a certain way, certain time of day, et cetera, et cetera. That doesn’t always work for each community that we do it in. Especially true when you come to taking the program to an outer island where life is very different from on Majuro. So it’s very important that you reach the people in a way that they will accept it and understand it. A lot of times that’s different everywhere you go.
Libon: Yeah, I think it is and then even when taking it out to the outer island, life in the outer islands is also different from here on Majuro.
Here, everybody’s always busy, but in the outer island, on Majuro, everybody’s always busy with something. But in the outer islands, everybody is so together. You call them for a meeting, they’re always together.
Sometimes it might not be a problem when you’re doing it in-person, but when you’re doing it online like Zoom call to do a class, then that’s where you might have the class, you might not have the class. I think for most people, they want you to be there other than looking at a screen. So outer island and Majuro, they really have different needs.
Mililani: Is there any background information you would like to share to reinforce the importance of this program for your community?
Libon: With the curriculum that we’re going with, it’s really helpful because it goes along with our culture. When you’re teaching a class and you’re including our foods, what kind of exercise we do.
Sometimes when you go to a site, like the communities, you might not have a place to do the class, so you don’t have a choice but to be outside.
MWC 2019-2022 Impact Report
Mililani: What impact has your site had on the communities you serve?
Tanner: For us, we’ve done 236 participants and about half of them completed the whole program; 2,492 pounds lost and over 600,000 total physical activity minutes. I think it’s three years since we’ve started the program.
That’s been really good results for us. We’ve had a lot of really great testimonies come out of there were people who have been able to turn things around before it got to diabetes. They were told they were borderline, didn’t know what that meant. But when they attended the classes, they had started to understand what it was and what the dangers were and were able to start exercising and eating right again and got things turned around.
We’ve been able to also establish partnerships with the local governments, the mayor’s associations on some outer islands. Notably, like Jaluit and Wotje, Ebon. Those places are either having active classes now or will very soon. And then we have extended projects where we’re incorporating gardening and cooking into the programming more to make it more sustainable.
Photo courtesy of MWC
Participants take part in MWC’s cooking demonstration
Mililani: What are some of your site’s challenges and/or best practices for recruitment, retention and general programming?
Libon: I think it’s been the same every year with our culture and all of that. Here in the Marshall Islands, everybody is a family. So whether your great-great-great-great-grandfather or grandmother were related, they’re always going to be there with families.
If you recruit without giving the understanding of what the program is or what they’re recruited for, then they’ll be like, “Hey.” They see somebody enrolling, they’ll be like, “I’ll like to enroll.” They start coming, coming, coming. And then the longer they attend, they just start to disappear. So what happens is I try to go to their houses. But it’s hard. It’s really hard. I don’t want to force them and sometimes I feel like I’m forcing them.
Photo Courtesy of MWC
Tanner: I think the best practice wise is it can’t just be education. It can’t just be the class. You have to make the class an event to go to.
Tanner: Like a birthday party. It’s another thing that they can go to and it becomes an extension of that community. Like Libon said, sometimes it’s really hard to keep patients coming back, especially for a year-long program, when you get at the end of it, and it’s only once a month that you technically have classes. We have a lot of out migration issues where people will go to the States, maybe stay there a month, maybe two, and then come back and we’re like, “Hey, where were you? You’re supposed to be at class.” So there’s a lot of those type of issues. And also the holistic approach to it, not just doing education but doing sports with it or Zumba classes or cooking classes, gardening stuff. Those really help with retention.
Mililani: What future projects and or goals does your site have for advancing diabetes prevention and promoting healthy lifestyles?
Libon: I believe there should be a day separated just to do screenings for pre-diabetes and just do lectures, games so not only does the adult know, but just anybody. It could be school, involvement, church involvement for this, and just do little games that are related to pre-diabetes, do screenings so people can understand where they are and not just saying, “Oh 101, you’re good, your sugar is good.” But screen them, tell them their numbers and tell them what it means. How can they prevent themselves? Because I really believe it should start with the little ones so that when they grow up, they understand the numbers of being told when they get older and they get screened. They know and they can prevent themselves at an early stage.
Tanner: Rewind the clock eight years ago, nobody was talking about it. So it’s something that is new enough that requires a lot of discussion and debate. I would even say do radio call-in shows like we’ve done, Libon’s done before where people call in and ask questions. That’s huge in my mind, because people are listening to that and it sparks debate. That’s what you want to do, is you want to spark that discussion and get people thinking about it and talking about it.
As far as projects go, we have plans to continue and expand to the outer island for the pre-diabetes and diabetes side of what we do at the wellness center. That’s our next phase, if you will.
Mililani: Can you expand a little bit more about that Tanner or Libon, about what that’ll look like when you guys do expand?
Tanner: Libon is training for a master coach now, and once that happens we’ll be able to train outer island lifestyle coaches. And so we have remote classes now on three atolls, and then once Libon is trained and certified as a master coach, that will change and we’ll put actual feet on the ground.
Libon: Because like I was saying earlier, in the outer islands, people like it more when you are there in person giving lecture than them looking at a screen. So I think with that master coach and training outer island lifestyle coach, it would be a really big advance for the program.
We thank Majuro Wellness Center’s Tanner and Libon for speaking with us during this week’s segment. Please stay tuned for our next site highlight!
To learn more about Canvasback Mission and MWC, please visit their website at https://canvasback.org/ and social media pages.
To support MWC in their pursuit of diabetes prevention and promoting healthy lifestyles, please contact Libon Jorkan at firstname.lastname@example.org for more information.