Pacific Islander Diabetes Prevention Program Storytelling Series: Kosrae Community Health Center

AAPCHO
10 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, sits down with site representatives to hear about their community stories and program impacts.

This week we spoke with Cecilia Sigrah of Kosrae Community Health Center (KCHC). KCHC is a community health center located on the Kosrae Island State in the Federated States of Micronesia. In this episode, Mililani and Cecilia share revealing data from KCHC’s 2019 population-based survey and impact report as well as speak about the importance of educating the next generation on diabetes prevention and healthy lifestyles.

Photo of the Kosrae Community Health Center logo

Cecilia: I’m Cecilia Sigrah working at the Kosrae Community Health Center as the operations manager. But with the Pacific Islanders Diabetes Prevention Program here at the community health center, I’m the coordinator as well as [one] of the lifestyle coaches delivering the program down here in Kosrae.

Mililani: My name is Mililani Leui and I’m the program manager for the Pacific Islander Diabetes Prevention Program.

Why is a program like this important for the community you serve?

Cecilia: Here in Kosrae, it’s a small island with a population of around 6,000, but non-communicable disease, it’s an issue here. The prevalence rate for diabetes is around close to 30% and with the adult population, this is 18 years and over, around 50% are either overweight, obese, or very obese. And knowing that obesity is one of the risk factors for developing these diseases or specifically diabetes- diabetes prevention, is very important here in our community. And, talking about pre-diabetes prevention, around one third of the population is at risk of developing diabetes or as if they’re at the pre-diabetes ranges. All these reasons really pose that it’s really important to have this program here in the island.

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

Cecilia: The curriculum for Prevent T2 comes in English, and most of our islanders, English is a second language. We really have to make these things really adaptable to them. For example, in the curriculum, some of the food items or even exercises, activities, it’s not what we are used to or our people are used to, so to make it more adaptable or for them to really accept it, we really have to bring it down into a context where our people are familiar with, and it’s easy for them to practice. With all these reasons, it’s really important that we tailor this program down to the context that is acceptable and adaptable by our communities.

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

Cecilia: We had a population-based survey on non-communicable diseases back in 2019 and the data revealed that close to 30% of our adult population that’s 18 years and over, they have diabetes. Meaning one in every three of our adults have diabetes. For the pre-diabetes ranges, it’s again one in every three, that’s close to 30% of our adult population are already there at the pre-diabetic ranges. Our changes, like lifestyle changes, people are now depending more on the processed food, the Westernized cultures, like there is less activity and all these things.

One of the three main things that we usually talk about is healthy eating, physical activity, and lifestyle change. With healthy eating, in our survey it also revealed that 95% of our adult population are not meeting the required fruits and vegetables consumption. Talking about all this, I think this again reinforces that the program is very important to our people, our communities.

KCHC 2017–2022 Impact Report
Photo Courtesy of PI-DPP

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

Cecilia: We have been running the program, this is our 6th year. From our past 5 years, we had enrolled around 457 participants and we had around 160 participants that actually completed the program. All these participants that completed the program, 38% of them, they had reduced their risk of developing diabetes, meaning they have either a 5% body weight loss, or they had reached a 4% body weight loss plus and have reached 150 minutes of physical activities per week, or some of them were able to reduce their A1C by 0.2%. And this really contributes to avoiding the complications that can develop from diabetes, and these are really huge impacts that add on our communities. Our people are relying on the Westernized foods, or more sedentary jobs, and less of physical activity. With our program, our participants [are] achieving an average physical activity minutes of around 424 minutes per week.

And this is a very huge impact on our participants because we were actually aiming for the recommendation was 150 minutes per week, but with the program being on and these people developing this habit, if we keep doing it, delivering the program, it will really have this impact on getting our communities more active and, in return, more having the chance to reduce the development of diabetes or even delaying the onset of it. Another thing that I think really was important to share is around 50 participants were able to achieve the 5% body weight loss.

Our participants giving that, I think this shows that it has an impact. The program has an impact on our communities. And if we are to continue on delivering this program and being robust in the near future we would have more, the impact would be even higher. It was really a positive thing when someone’s losing weight and people were asking, “Is so-and-so in your program?” And this is a very positive message that they know these people are in the program, and working on weight loss and being more happy and all of these things.

With that, we smile around it, but this is a very positive impact on our program, knowing that our people recognize our program as a prevention strategy towards diabetes or something like that.

There are a few of our participants that completed the program that shared that over the several years they’ve been told by the health workers that they are at risk of developing diabetes. Even some of them, they were told that they have diabetes or they’re at risk of developing diabetes during pregnancy and all those things. But after being in the program for one year, or some of them even went for the second year, and they were telling us that they have better fasting blood sugar results or even A1C results, and they had their next pregnancy and they were not being told like before, their blood sugars were in the normal ranges and all. With this sharing and testimonies that they have with us, we feel that yes, the Pacific Islanders Diabetes Program really had an impact on our communities.

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

Cecilia: At first with recruitment, we were really working close with the community health center clinics, we have three on the island, and with the non-communicable disease at the main hospital, and we only have one hospital on the island. We were able to work with these clinics and get their free diabetes registries. We had all the listings of the names of these people and all, but when we go to them, they have their right to refuse and all. And most of the time, these people are not yet ready.

The clinic started in 2016, and when we started the program in 2018 down here in Kosrae, we had close to 100 or 100 plus in one of the clinics that were at the registry for pre-diabetes. And I think when we went around trying to recruit these people, most of them were not ready. They’re already eligible by the blood sugar testing, but then it’s not yet there with them that it’s important for them to be in the program. One of the things we found out to be very effective is having the clinician, especially the doctor, referring that person to us. In the later years, we were able to have some participants coming in as advised by their clinicians. And the other thing is we usually have a lot of participants at the beginning. Session one, sometimes we have around 28 participants.

And along the way, when it comes down to close to the end of the first phase, that’s around close to the first six months, and of the first six months, we had maybe 12 participants or a little bit more, like 12 to 15. And down to the end of the program, we were left with I think 10. It’s hard to retain most of our participants until the end of it, the 12-month-long program. One of the things that we do is when it comes to those sessions where it’s spaced apart, once a month, that’s at the second place, month 7-to-12, we usually put in some retention activities, like physical activity interventions, or have a speaker come and talk about food, or stress, or doing cooking demonstrations and all.

I think that’s one of the things that we do in addressing retention, and then we have small tokens of appreciations or little incentives. It’s really related to physical activity or healthy nutrition promotion and all, so we keep farmer fish vouchers or local produce vouchers where if they reach a certain milestone, we give them those vouchers at certain values, maybe a $20 fish voucher, where they can go to the markets and get some local fish or seafoods, or go to the local produce market and get some cabbage, some tomatoes, and cucumbers, and all those things. And one of the other things is they’re comfortable at home. So, during recruitment, we have the community health workers or nurses doing the recruitments house to house, going visiting the houses and introduce the program. And if they’re willing to attend, ready, then they fill out the enrollment form.

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

Cecilia: One of the things we are having our discussion over is building and strengthening our relationships with employers so we can look into delivering the program at their work site. I think those employees have certain work sites in the program. If we have the endorsement from the leadership or senior managers for those employers, we feel that it’s going to be easy to deliver the program in there. And the other thing that we are having our discussions over is having community health improvement projects, little mini projects that we can have to, kind of, intervene earlier on. There are a lot of youths under 18 that are really wanting to be in the program, but our program is for 18 [years] and over. Even currently in our classes here in Kosrae, we allow three to five ineligible participants. Most of them are under 18, or they’re already diabetic, or they’re not eligible meaning they’re not overweight, their blood sugar testing is not within that pre-diabetic ranges.

For one of my classes, I have around four or five participants that are below the age of 18, ranging from age 9 and up to 17, I think, or 16. They’re really familiar with the program, and even at younger ages, they’re like, “How many calories are in that soda?” And even the younger ones, they used to come over and sit in the sessions, and they’re like, “I’m not drinking soda because it’s bad for my health.”

Our conversations down here at the organization, we’re really looking into seeing how we can address the younger generations or even the youths that are under the age of 18. These are some of the things that we’re looking into so that they can have an earlier introduction into the program or even knowing the preventive measures or practicing it earlier on so that they can have a better chance of preventing these non-communicable diseases, or specifically with our program, diabetes, or even the risk factors like overweight and all.

Photo of Cecilia smiling with a flyer that says, “How do you fight diabetes? With a BIG HEART!”

We thank Cecilia (pictured above) from Kosrae Community Health Center for speaking with us during this week’s segment. Please stay tuned for our next site highlight!

To learn more about KCHC, please visit their website at https://kosraechc.org/ and Facebook.

To support KCHC in their pursuit of diabetes prevention and promoting healthy lifestyles, please contact Cecilia Sigrah at sigrahcecilia@gmail.com for more information.

Facebook: @KosraeCHC

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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.