A Transcultural Nursing Approach to Secondary Prevention of Pressure-Related Foot Injury in Micronesian Migrants in Hawai’i with Type 2 Diabetes Mellitus

Norris-Taylor, Joyce
Thornett, Tracy
Davis, Alice
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The newest members of the State of Hawai’i come from Micronesia under provisions of The Compacts of Free Association (COFA). In Micronesia, COFA citizens face unique challenges as a result of their association with the United States including the legacy of nuclear testing along with ongoing damage as a result of rising sea levels with saline leaching making land uninhabitable as the total land mass is diminishing. COFA citizens have the legal right to come to the United States and they are coming for educational opportunities, employment opportunities, and for health care. In Hawai’i, the Micronesian population has been met with prejudice, injustice and neglect. The health care issues of Micronesia include both the communicable diseases of a developing area as well as the noncommunicable diseases of a developed region including type 2 diabetes mellitus. Poverty, lack of natural resources, poor nutrition, and a sedentary lifestyle promote both communicable and noncommunicable diseases in this vulnerable population. Migration to Hawai’i provides opportunities to receive education, employment, and health care not available in native lands. The high prevalence of type 2 diabetes in COFA migrants presents many opportunities to pursue secondary prevention measures in this population. In the Micronesian population traditionally, as is common in tropical climates, footwear is minimal or nonexistent leaving feet exposed to injury. The overarching goal of this project was to address one aspect of secondary prevention in the Micronesian migrant population residing in East Hawai’i, preventative foot care in the diabetic. With the aid of a cultural interpreter a pilot study was conducted with participants surveyed as to footwear preferences. With the expert advice of a podiatrist and the guidance of the cultural interpreter, prototype safer alternatives to commonly worn footwear were developed. The prototypes were trialed over a one-week period after which a secondary survey was performed. Of the prototype trial participants, 100% liked the shoes, wore the shoes, and desired to keep the shoes. Cultural adaptations are required for successful promotion of self-management of chronic conditions including obesity and diabetes. Collaboration with COFA stakeholders will afford better outcomes for Micronesian citizens. To date, the healthcare community has failed to engage this population largely due to Western medicine ethnocentrism and paternalism. This pilot study demonstrated the willingness of the Micronesian migrant community to partner with healthcare providers for rational lifestyle changes to improve overall health.
Micronesia (Federated States), Footwear, Non-insulin-dependent diabetes, Compacts of Free Association
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