Marshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities. A community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions. The article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol. The article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.

The purpose of this study is to explore the beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding intent among Marshallese pregnant women in the United States (US). The study used a descriptive qualitative design. In total, 36 Marshallese women in their third trimester of pregnancy participated. Participants described exclusive breastfeeding as the preferred method of infant feeding, from both individual and community perspectives. Exclusive breastfeeding was viewed as the healthiest for the infant, viewed as offering protection against sickness, and viewed as better for the overall development of the infant. Of the 36 participants, 28 participants (77.8%) stated that their infant feeding intentions included a hybrid of breastfeeding and formula feeding. The dominant barrier to exclusive breastfeeding was the need to work outside of the home. Unexpected barriers to exclusive breastfeeding were the desire for autonomy and a preference to exclusively breastfeed female infants more than male infants. Exclusive breastfeeding facilitators included support from the Special Supplemental Nutrition Program for Women, Infants, and Children and support and encouragement from female family/community members. This study is the first to document beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding among Marshallese pregnant women residing in the US.

Background: Pacific Islanders in the United States have lower initiation rates and shorter duration of exclusive breastfeeding compared to other racial/ethnic groups. Research Aim: To describe infant feeding beliefs and experiences of Marshallese living in the United States. Methods: We used a prospective and cross-sectional exploratory, descriptive qualitative design with Marshallese participants ( N = 36) residing in the United States between July 2019 and July 2020. Data were collected at 6–8 weeks postpartum. Our qualitative analytic approach integrated inductive and deductive techniques. Results: Participants’ mean age was 27.1 years ( SD = 6.1), and 88.9% ( n = 32) were born in the Marshall Islands. A majority of participants were single, widowed, or in an unmarried partnership ( n = 28, 77.8%). Most participants had a high school education or lower ( n = 30, 83.3%). Mean household size was 7.2 ( SD = 2.8). Fewer than half of participants had no health insurance ( n = 14, 38.9%), and almost all participants (91.7%) did not work at the time of data collection. Two themes emerged: 1) infant feeding initiation and practices; and 2) concerns over breastfeeding in public. The majority of participants’ infants received both human milk and formula. Participants described beliefs that breastfeeding in public was against American customs, which influenced their decision about breastfeeding in public. Conclusions: Our study was the first to document infant feeding beliefs and experiences of Marshallese living in the United States at 6–8 weeks postpartum. Findings will inform future health education programs.