Culturally Appropriate DPP Intervention for Arab Americans

Implementing a diabetes prevention program (DPP)-adapted, culturally-appropriate, group lifestyle intervention is feasible and effective in the Arab American population, said to Linda A. Jaber, PharmD, professor at the College of Pharmacy, Wayne State University, in a symposia presentation at the 2010 American Diabetes Association’s 70th Scientific Sessions titled “Adaptation of the DPP Lifestyle Intervention for the Arab-American Community in Detroit.”

There are 22 countries included in the Arab Nation, and the people who hail from those nations are disproportionately affected by diabetes. In fact, six of the 10 countries with the highest rates of diabetes are Arab countries. The prevalence also carries over in America, where Arab Americans are also disproportionately affected by the disease. This is demonstrated in Dearborn, MI, which has the second highest concentration of Arab Americans outside of the Middle East (after Paris); over a third of Dearborn’s population is Arab and 60% of their schools are composed of Arab children.

With Dearborn serving as a backdrop for an Arab American diabetes study, Jaber and colleagues set forth to assess the feasibility of a community-based, culturally-specific, DPP-adapted, group lifestyle intervention in the Arab population. They conducted focus groups that included self-identified Arab Americans over the age of 30 with a BMI over 27 and no prior history of diabetes. The focus groups, composed of 10-12 people each, underwent an orientation session in which participants were informed of lifestyle and educational intervention strategies. They were taught to identify and modify health beliefs that could put them at risk for diabetes, which in turn would help improve their knowledge of the disease and its risk factors. The lifestyle intervention, which was a modified version of a DPP intervention, provided them with the goals of achieving a 7% reduction in their initial weight, and a getting at least 150 minutes a week of moderate physical activity. The emphasis was on healthy lifestyle choices with simple dietary modifications and increased physical activity (an example of a simple dietary modification given by Jaber was the use of olive oil in cooking).

There were several key features of the study that proved critical in helping the investigators achieve their goals. The study featured peer mentoring, with participants serving as coaches, and was community-based and family-centered, which is extremely important in Arab culture. It also used culturally-specific strategies and was delivered to a group instead of individuals. The study featured several learning formats—many of which were based on cultural themes—including healthy food demonstrations, food replicas to show portion control, ethnic recipe sharing, the promotion of brisk walking, and an emphasis on recording body weights, food types, and portion sizes, as well as the ability to identify high-fat foods. This curriculum was given to the groups in weekly sessions over a 12-week period, with follow-up at 24 weeks.

Of the 71 people included in the 24-week lifestyle intervention, 44% achieved at least a 7% reduction in their initial body weight, compared to 50% of the control group; the average person lost 5.2 kilos. Family support was also significantly associated with weight loss, as those who had a family member involved in the study as well lost more weight than those who did not. There was also a significant improvement in achieving the minimum of 150 minutes a week of moderate physical activity.

Dr. Jaber pointed out that the small sample size, self-selection criteria, and short-term outcomes evaluated were limitations of the study. Still, she maintained that this type of DPP-adapted, culturally appropriate, group lifestyle intervention can be effective and feasible in an Arab American population, and she would like to see it performed in a larger sample size.