Implementation of a culturally tailored diabetes intervention with community health workers in American Samoa.
The purpose of this article is to answer key implementation questions from our translation research with a primary care-based, nurse-community health worker (CHW) team intervention to support type 2 diabetes self-management.



Descriptive data are given on intervention delivery, CHW visit content, patient safety, and intervention costs, along with statistical analyses to examine participant characteristics of higher attendance at visits.



In the intervention sample (n = 104), 74% (SD = 16%) of planned intervention visits occurred, guided by an algorithm-based protocol. Higher risk participants had a significantly lower dose of their weekly assigned visits (66%) than those at moderate (74%) and lower risk (90%). Twenty-eight percent of participants moved to a lower risk group over the year. Estimated intervention cost was $656 per person. Participants with less education were more likely to attend optimal percentage of visits.



A nurse-CHW team can deliver a culturally adapted diabetes self-management support intervention with excellent fidelity to the algorithm-based protocols. The team accommodated participants' needs by meeting them whenever and wherever they could. This study provides an example of adaptation of an evidence-based model to the Samoan cultural context and its resource-poor setting.
Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island, USA (Dr DePue, Dr Rosen, Dr Bereolos)|Alpert Medical School at Brown University, Providence, Rhode Island, USA (Dr DePue, Dr Rosen)
Judith D
JD
DePue
Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island, USA (Dr DePue, Dr Rosen, Dr Bereolos)|Alpert Medical School at Brown University, Providence, Rhode Island, USA (Dr DePue, Dr Rosen)
Rochelle K
RK
Rosen
International Health Institute & Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA (Mr Seiden, Dr McGarvey)
Andrew
A
Seiden
Centers for Behavioral and Preventive Medicine, the Miriam Hospital, Providence, Rhode Island, USA (Dr DePue, Dr Rosen, Dr Bereolos)
Nicole
N
Bereolos
Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, Maryland, USA (Ms Chima)
Marian L
ML
Chima
VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina, USA (Dr Goldstein)
Michael G
MG
Goldstein
Tafuna Clinic, American Samoa Community Health Centers, Department of Health, Pago Pago, American Samoa (Mrs Nu’usolia, Dr Tuitele)
Ofeira
O
Nu'usolia
Tafuna Clinic, American Samoa Community Health Centers, Department of Health, Pago Pago, American Samoa (Mrs Nu’usolia, Dr Tuitele)
John
J
Tuitele
International Health Institute & Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA (Mr Seiden, Dr McGarvey)
Stephen T
ST
McGarvey
D000328:Adult; D000465:Algorithms; D018948:American Samoa / Q000453:epidemiology; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D003153:Community Health Services / Q000458:organization & administration; D003150:Community Health Workers / Q000458:organization & administration*; D055812:Community-Based Participatory Research; D003362:Cost-Benefit Analysis; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000517:prevention & control*; D004032:Diet / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D057185:Sedentary Behavior; D012648:Self Care; D012959:Socioeconomic Factors; D014507:Urbanization / Q000639:trends
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human