Impact of Cultural Understanding on Diabetes Prevention, Article Critique Example

Non-insulin-dependent diabetes mellitus (NIDDM) is agrowing problem in developing countries. The increased consumption of modern and industrialized foods over more traditional and local foods causes Marshallese diets to be higher in fats and refined sugars, while being lower in the consumption of fiber. Lifestyle factors such as weight control and activity level are key elements in managing NIDDM. However, implementing these lifestyle changes is often difficult in non-industrialized countries due to a lack of cultural understanding. In the article Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands, the authors evaluate how Marshallese culture, beliefs, and activities affected body size, weight, and predisposition to diabetes. Because many Marshallese people do not have access to adequate health care, prevention is essential in managing NIDDM.

Data was collected in three phases using interviews, surveys, and observation of Marshallese customs in both urban and remote environments. Qualitative and quantitative methods were used to evaluate patterns and perceptions of food consumption and preparation, the relationship of body size andhealth, and the general knowledge of NIDDM. The first phase was a quantitative survey that collected information on 150 households in urban and remote areas. Data included height and weight, and the frequency of the consumption and preparation methods of over 100 various local and local and store-bought foods. The second phase involvedgathering qualitative data regarding the beliefs and perceptions of food, activity, disease, and body size.Detailed interviews were conducted on more than 30 participants within the community. Non-formal interviews were also conducted with 25 participants in both urban and remote settings where participants listed as many different foods and diseases as they could.  Thirty-three urban participants were asked to sort food into different sections. Ten urban and remote participants were asked to rank listed foods from highest to lowest fat content. Participants were also asked about perception of body size in relation to health and attractiveness.The third phase of the study included the collection of qualitative data on the eating habits of the Marshallese people. Twenty households were observed during mealtime, factors such as portion size, food sharing, and the feeding of children and infants. The “Knowledge, Attitudes, and Beliefs (KAB) Survey” assessed the participants’ agreement or disagreement with statements regarding food, diabetes, activity level, and body size. The data was analyzed using Anthropac software program, a multidimensional scaling (MDS) procedure, and hierarchical clustering analysis of food groupings.

The study showed that cultural customs of the Marshallese people affected their perceptions of weight, health, and NIDDM. Though a general knowledge of the Marshallese culture was obtained, the methods used to gather the data could have been more organized to collect more substantial data. Consistent population samples could be used from a greater variety of locations, enabling stronger information regarding culture in both urban and remote settings. The authors admit that the study was limited in that the majority of the qualitative data was conducted in only one urban and one remote area. Though the methods may have been disorganized, the study was overall successful in obtaining relevant information on Marshallese cultural customs and perceptions which can be used to develop more effective programs in the prevention of NIDDM.

References

Cortes, L. M., Gittelsohn, J., Alfred, J., Palafox, N. A. (2001). Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands. Health Education & Behavior, 28, 696-715.