Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands

Health Educ Behav. 2001 Dec;28(6):696-715. doi: 10.1177/109019810102800604.


Formative research was conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two main conceptual spheres: foods from the islands/Marshallese foods and imported/American foods. Diabetes (nanimij in tonal) is a highly salient illness and is believed to be caused by foods high in fat and sugar, consumption of imported/American foods, family background, and the atomic bomb testing. Physical activity and eating a traditional diet were viewed as important for preventing diabetes. The traditional belief system links a large body with health, and a thin body with illness; however, perceptions are changing with increased acculturation and education about the health risks of obesity. These findings were used to develop a diabetes prevention home visit intervention currently being implemented and evaluated in Marshallese households.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Body Constitution
  • Body Mass Index
  • Cultural Characteristics
  • Diabetes Mellitus, Type 2 / etiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Dietary Fats / adverse effects
  • Feeding Behavior*
  • Food Preferences
  • Health Education*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Medicine, Traditional
  • Micronesia / epidemiology


  • Dietary Fats