Cherokee choices: a diabetes prevention program in Cherokee, North Carolina.

ncmedicaljournal.com 394 NCMJ vol. 72, no. 5 ncmedicaljournal.com effective in ensuring that culturally relevant approaches are developed. A critical first step is increasing awareness of the behaviors associated with diabetes prevention and control. This is the goal of the American Indian and Alaska Native Workgroup of the National Diabetes Education Program, with initiatives such at the Move It and the Power to Prevent campaigns. These initiatives focus on encouraging increased exercise, healthy eating, and maintenance of healthy body weight by American Indian youths and adults, lifestyle behaviors that were shown by the Diabetes Prevention Program to reduce the risk of diabetes [11]. Furthermore, community-level policies need to encourage access to healthy foods and safe and affordable venues to exercise. A 2009 study showed that residents who lived in neighborhoods with more of these resources had a 38% lower risk of developing diabetes, compared with those in neighborhoods with fewer resources [12]. Given that many of the state’s American Indians live in rural areas, this presents some challenges. However, community-based organizations that are important in American Indian communities, such as faith-based institutions, can play an important role in disseminating health education information and in providing places to exercise and share healthy foods. The training and support of lay health educators has been shown to be a cost-effective approach to impart this education [13]. Another important component in reducing diabetesrelated disparities in American Indian communities involves ensuring that culturally competent health care professionals with particular expertise in diabetes management are available. Again, since many of the state’s American Indians live in rural populations with limited means for transportation, this is a major challenge. An additional complicating factor is that many in the state’s American Indian populations have limited or no health insurance, making access to diabetes specialty care even more difficult [14]. Even among members of the EBCI, who have access to health care through the Indian Health Service, resources for treating the large number of residents with diabetes, many of whom live long distances from health care facilities, are limited. Finally, researchers need to work with American Indian communities to translate findings from diabetes prevention and control research studies in order to generate the broadest impact. As an example, Katula and colleagues [15] recently demonstrated promising results in translating the Diabetes Prevention Program intervention for use by low-income African Americans in Forsyth County, North Carolina. This collaborative approach requires a high level of trust and a mutual respect among partners. Cherokee Choices: A Diabetes Prevention Program in Cherokee, North Carolina