Barriers and opportunities: a community-based participatory research study of health beliefs related to diabetes in a US Marshallese community

Diabetes Educ. 2015 Feb;41(1):86-94. doi: 10.1177/0145721714559131. Epub 2014 Nov 14.


Purpose: This study investigates the beliefs and perceptions related to type 2 diabetes that influence diabetes self-management behaviors for Marshallese in the United States. Using the health belief model as a theoretical framework, the researchers seek to better understand the underlying beliefs that motivate or impede diabetes self-management behaviors.

Methods: The community-based participatory research (CBPR) collaborative engaged in 14 months of preliminary fieldwork and conducted 2 tiers of focus groups for this project as part of the long-term commitment to reducing health inequalities in the Marshallese community. The CBPR team conducted an initial round of 2 exploratory focus groups (n = 15). Based on the knowledge gained, researchers held a second round of focus groups (n = 13) on health beliefs regarding diabetes. All participants were Marshallese, aged 18 years and older, and included men and women. Participants either had a diagnosis of diabetes or were a caretaker of someone with diabetes.

Results: The findings elucidate the structural and nonstructural barriers to successful diabetes self-management for Marshallese in the United States. Barriers include eating differently from the rest of the family, social stigma of diabetes, transportation, cost, lack of access to health care, and cultural and language barriers.

Conclusions: While there are significant barriers to improving diabetes self-management, there are also areas of opportunity, including family and peer reinforcement to encourage proper diabetes management behaviors and a growing community desire to lift the stigma of diabetes. The CBPR team offers recommendations to make diabetes management interventions more culturally appropriate and effective for the Marshallese population.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Communication Barriers
  • Community-Based Participatory Research
  • Diabetes Mellitus, Type 2 / ethnology
  • Diabetes Mellitus, Type 2 / psychology*
  • Female
  • Focus Groups
  • Health Behavior / ethnology*
  • Health Knowledge, Attitudes, Practice / ethnology*
  • Health Services Accessibility
  • Humans
  • Male
  • Micronesia / ethnology
  • Middle Aged
  • Self Care / psychology*
  • Social Stigma
  • United States