Land, food and health: Cultural-based education and chronic disease self-management

Background: The high prevalence of diabetes in Native Hawaiians and Pacific Peoples (NHPP) has prompted the need for culture-based health education programs. Successful strategies for diabetes self-management programs are emerging but often do not incorporate the differing lifestyle, values and beliefs of ethnically distinct groups. Researchers in the field of education have shown culture-based education to be effective with indigenous and ethnically distinct populations. Kokua Kalihi Valley Comprehensive Family Services center (KKV) developed a culture-based diabetes self-management program tailored to their patient population. Healthy Eating and Lifestyles Program (HELP) uses culture-based education strategies and socio-emotional development to promote health educational outcomes. HELP builds on NHPP's foundational value of physical, emotional and spiritual relationship to land to engage and enhance chronic disease self-management.

Methods: HELP combined a once a month, six month classroom education with a twice a week communal garden as a physical activity component. The custom classroom curriculum was developed by KKV based on the American Association of diabetes educators' seven diabetes self-care behaviors.

Results: Preliminary data shows an average starting HbA1C level was 10.74 and after the program, HbA1C dropped to 9.39, a meaningful reduction of 1.34 (p<0001). Recent studies have shown that a reduction in HbA1C directly correlates to risk reduction. Participants reduced their risk of microvascular complications from diabetes and deaths related to diabetes by 37% and 21%, respectively.

Conclusions: Increases in cultural identity, self-worth through use of language, cultural content, and cultural context in health education can result in increased engagement, achievement and behavioral modification.