Background: Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity. Objectives: We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese. Methods: Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts. Lessons Learned: Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality. Conclusions: We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others’ work with Pacific Islanders.

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.

Study participants express a desire to receive the results of studies in which they have participated even when the results are not what researchers expected. Sharing results with participants is a core principle of community-based participatory research (CBPR), however, many researchers using a community-based participatory approach report that they encounter barriers to sharing results with study participants. Researchers at the University of Arkansas for Medical Sciences established a CBPR partnership with Marshallese community stakeholders in an effort to reduce the health disparities of this vulnerable population. Marshallese are a Pacific Islander population that faces significant health disparities and have a high prevalence of diabetes, obesity, obesity-related cancers, and other chronic diseases compared to the general US population. A qualitative descriptive design was used to evaluate Marshallese participants' perceptions related to receiving results of a culturally adapted Diabetes Self-Management Education randomized control trial in which they participated. Participants were provided with a summary of their individual results as well as preliminary, overall aggregate study results. Interviews were conducted with half of (N = 111) of the 221 enrolled participants that provided them with the opportunity to share in-depth responses related to their perceptions of the study results they received. There was no statistically significant differences between study arms in participant desire to receive overall study results, desire to receive personal study results, or willingness to participate in future research. Participants described their desire for results and the effect of these results on their future behavior. Within the a priori theme of participants' desire for results, three subthemes emerged: 1) results showed current health status, 2) results showed improvement, and 3) demonstrated the overall results of the study. Within the a priori theme of effects of results on future behavior, two sub-themes emerged: 1) encourage future healthy behavior, and 2) encourage future research participation. Participants overwhelmingly stated they wanted to receive personal and aggregate study results. This finding is consistent with previous qualitative studies that documented that participants want results. Marshallese participants also reported that receiving study results would affect their future health behavior. This study documents specifically how participants anticipate using the results of studies in which they participated. The study is registered in clinicaltrials.gov (#NCT02407132).