Pacific Islander Diabetes Prevention Program Storytelling Series: Belau Medical Clinic

AAPCHO
8 min readSep 27, 2023

This blog post was originally posted on the Pacific Islander Diabetes Prevention Program website.

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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 Pearl Marumoto of the Belau Wellness Center, as part of the Belau Medical Clinic (BMC). Belau Wellness Center is a non-governmental organization based in Koror, Palau that focuses on the well-being of Palau’s residents. In this episode, Mililani and Pearl speak about community-tailored retention strategies in response to the challenges of living on a small island, as well as the importance of lifestyle coaches in participants’ health journeys.

Lifestyle Coach Group Photo
Photo Courtesy of BMC

Pearl: My name is Pearl and I’m from Palau and my title is Executive Director for the Belau Wellness Center, which is an NGO in Palau that focuses on the well-being for the citizens and residents in Palau.

Mililani: My name is Mililani and I am the Program Manager for the Pacific Islander Diabetes prevention program.

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

Pearl: Well, the program is very important because it shows us from coming from small islands, we don’t have a lot of infrastructure to see what we need to do to improve our health. So, such program like this gives us an opportunity to explore what we have on the island. The reason why I particularly think this program is so important, it gives us an opportunity to gather evidence-based information for us to look at-what is our health status and who we are, so we can define what are the next steps to change policy to make a better health outcome for our citizens.

PI-DPP Participants pose for a photo during a support activity
Photo Courtesy of BMC

Mililani: Why is it important to tailor the program to your community’s specific needs? Mililani: Is there any background information that you would like to share to reinforce the importance of this program for your community?

Pearl: It’s very important to understand specific needs for our target population is to integrate learning modules from the community, from the grants, from the science, from the programmatic areas, from policies to really understand how people in the community respond to a specific program that gets to be deployed in terms of, particularly in health. If we don’t use integrative learning that’s targeting specific needs, it’s going to be very hard for us to reach a tipping point or any behavioral changes to improve health status or individuals in the community as well-as a whole.

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

Pearl: Living in a small island, we’re very inundated by challenges. Everything is imported, and living in small islands going through urbanization processes that we might not understand. You know, a very challenging look at well-being and wellness in the community.

We are flexible to bring the program to the location where the people are. We learned where these people are located so that we can look at the environments that they’re in, it may be in their community centers or in their offices.

As for populations, we need to understand our demographics in terms of rural versus urban settings, employed and unemployed, educated versus not educated, to tailor the program to meet their specific needs and make it enjoyable as part of our retention.

It’s very challenging to live in an island where everything gets imported. [The] food market is being dominated by processed foods. The innovation with this program, we wanted to introduce the farming to table concept as part of the program and also understand the food market in terms of buying power for participants to buy processed foods vs. locally-sourced food.

BMC 2019–2022 Impact Report
Photo Courtesy of BMC

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

Pearl: Well, the impact is huge. It introduces a concept to define services that would promote wellness and well-being. For data, this program was able to collect our data which was [a] very reputable point in formulating policies and show to policy makers what can be changed to impact the greater good for Palau. So, we used the data to promote and introduce wellness screening to our national health insurance.

Belau Wellness Center group providing community wellness screenings during a community walkathon.
Photo Courtesy of BMC

Community-wide lifestyle changes, the program gave us the opportunity to launch and implement integrative approach, using this program from farming to dancing to music to stress management to whatever approach that the community defines that it’s well-adapted to them. We were able to use integrative approaches to enhance and increase the well-being of individuals and the community.

Belau Wellness Center co-sponsoring a farm to table event with Palau High School’s Agriculture class to showcase healthy eating habits. The event was held in partnership with the Bureau of Agriculture, Ministry of Education, Palau Community College-Cooperative Research Center, Palau Rotary Club.

The program also reinforced established partnerships that we’ve been working on, but it still gave us the opportunity to formalize as an integrative approach to one household or to one individual or to one community. So, there’s that approach that we look at using that established partnership, we talked about food security at the household level, nutritional intake increase through urban gardening in the individual homes and in the community as a collective group — so it gave us that opportunity through our established partnership to have that dialogue with the state governments, NGOs, grantors, programmatic partners, so it gives us that avenue to have that dialogue, but not just dialogue that actually implement that on the ground. It gives us new synergies, these kind of projects.

A BMC lifestyle coach conducts a water aerobic support activity for participants
Belau Wellness Center certified LC providing community access for HIIT classes free of charge for anyone
Photo Courtesy of BMC

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

Pearl: Challenges, in terms of recruitment and retention, it’s the duration of the program. Sometimes, it’s very hard to do a year project or a year program. It gets too long. So, part of the challenge is for the program to find innovative strategies to make it more interesting.

Also, in the small islands, there’s so many programs. There’s this new program, we don’t come together, so we go to the same target population and the community gets fatigued.

Cooking classes, because we don’t have chefs that can understand what is the healthy way of cooking, to sit down and have a dialogue with the concept of healthy cooking gets a little challenging.

BMC hosts a variety of support activities for participants including music lessons (left) and outdoor gardening demonstrations (right)
Photo Courtesy of BMC

For best practices, we know that if we let the life coaches in the community define activities that they like to do and not have a lot of restrictions, they’re more likely to stay together and finish the program. So, the flexibility of the program to let the coach and the participant define their own activities, makes the class successful and retain the attendance and finish the classes. We know that once we implement these music, learning how to play instruments like ukulele, harmonica, and dancing, are very popular and adds on to the program.

The consistency for the life coach to show up, also makes this program very successful. So, it establishes the trust and they get to know each other in a friendly way that continues after their classes. Part of the best practices is life coaches [inaudible] collecting the data and understanding what data means for this program to use to change policy in Palau.

Volunteers of Belau Wellness share the same passions and commitments to improve Palau’s wellbeing as a country. Here, volunteers pose for a group photo.
Photo Courtesy of BMC

One of the best practices are the life coaches who absolutely believe in the cause and doing this on a volunteering basis. The best practices is having a common goal, understanding where we want to go as a group and then, understanding that data, volunteerism, and wanting to make Palau a better place for the next generation.

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

Pearl: The next project I would like to use this platform and go segway into is getting to the household level and find out our fatalism attitude towards diabetes. Looking at the national data and our data from this program, it is evident that we have high diabetes rates. I want to understand how, as Palauans, look at diabetes through our fatalism lens. Because I hear in our own cultural context that “It’s okay, my parents had diabetes and they died of diabetes. I’m going to be having diabetes, so…I’ll just keep doing what I’m doing.” So, I want to go in and see what is our fatalism attraction to diabetes. We can really understand what kind of a healthcare system we’re building toward the future.

We thank Pearl from the Belau Medical Clinic for speaking with us during this week’s segment. Please stay tuned for our next site highlight!

To learn more about BMC, please visit their Facebook page at https://www.facebook.com/belaumedicalclinic/

To support BMC in their pursuit of diabetes prevention and promoting healthy lifestyles, please contact Pearl Marumoto at pmarumoto@gmail.com for more information.

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AAPCHO

The Association of Asian Pacific Community Health Organizations — dedicated to promoting advocacy, collaboration and leadership to improve AA and NHPI health.