A Perspective on Diabetes from Indigenous Views

Photo by Andrew James on Unsplash INTRODUCTION Since its inception, bioethics has focused on Western conceptions of ethics and science. This has provided a strong foundation to build bioethics as a field and discipline. However, it has largely failed to consider non-Western systems of ethics and science like Indigenous American thought frameworks. This has important implications for the treatment of Indigenous Americans in healthcare settings, something that I have considered as a mixed Indigenous American researcher of sociology, global health and bioethics. While there has been recognition of other thought frameworks impacting bioethics, these have largely focused on differences among religions and their adherents. While religious frameworks are important, bioethics must also recognize, learn, and implement different cultural frameworks. Bioethics cannot simply recognize these non-Western frameworks; it must also legitimately incorporate them as frameworks. Non-Western conceptions have too often been used in a secondary status or as a historical outlier or curiosity which leads to failure in integrating non-Western frameworks to their full extent and benefit. BACKGROUND Indigenous American philosophy has strong foundations throughout North and South America[1] that can provide a base for developing Indigenous-focused bioethics. While Indigenous Americans cannot be considered a monolith, there are similarities across Indigenous cultures in their approach to reality—developing Indigenous bioethics will necessarily incorporate these shared philosophies.[2] These similarities are present in the US philosophical tradition of pragmatism. Pragmatism arises from the Indigenous pragmatism which values interacting with other beings and the environment, plurality of thought, connections to the community, and growth from the other three dimensions.[3] This shared pragmatism centers the actions of individuals as the defining feature of maintaining balance in all scenarios of socializing and work—achieving the “center good.” [4] Tlacoqualli in Monequi is a Mexica (Aztec) saying that translates to the “center good is required” and means “middle way of being” or consistently managing imbalances and obligations to achieve a long-term balance. For example, indulging in excesses requires the opposite to follow: making do with less for a period or balancing receiving with giving.[5] The actions of individuals must maintain the balance, which simultaneously encourages self-responsibility and responsibility to the community.[6] Additionally, the individual is not judged only by their actions but also by their omissions—failure to act either unintentionally or intentionally—and judged on the morality of their decision as if they had acted.[7] There have been calls for developing Indigenous bioethics,[8] including analyses of important distinctions between Western and Indigenous ethical approaches to health care such as how Indigenous patients understand core bioethical concepts like autonomy and non-maleficence.[9] These differences in thought impact all aspects of Indigenous health care and how providers approach fundamental tasks like revealing diagnoses or encouraging surgeries.[10] Indigenous ethics place great value on individual decisions made in the context of community input. Failing to appreciate this cultural difference can prevent an Indigenous patient from maintaining the center good and therefore violate a fundamental aspect of being.[11] Providers must also understand the nuances of religion and Indigenous ethics. While many Indigenous people adhere to elements of Christianity or other religious philosophies, many Indigenous people still maintain traditional cosmovisions.[12] These cosmovisions—ways that Indigenous communities understand life, earth, the universe and its moral constructs—demand adherence not to a supreme ethereal deity but to Indigenous pragmatism and, therefore, the “center good” so that an individual can live a happy and healthy life. Failing to adhere to the cosmovisions results in the decay of that person, and even their community, on physical, emotional, and spiritual levels.[13] ANALYSIS Previous work on Indigenous bioethics has referred to Indigenous philosophies in a secondary way. This placement of Indigenous ethics onto a second tier still demands that Indigenous patients adhere to dominant Western ethical discourses. Indigenous pragmatism calls for a plurality of thought and method. This means that Western ethics can apply in the treatment of Indigenous patients, but that Indigenous ethics must be on an equal plane or elevated above Western ethics in the treatment of Indigenous patients. The Indian Health Service (IHS) in the US provides an example. This system is treaty-obligated to provide health care to Indigenous Americans, the only racialized group in the US to have federal government-provided healthcare. However, many providers in the expansive IHS system operate from a Western ethic. This viewpoint leads to negative interactions and miscommunications.[14] It also adds to the persistent racism and ethnocentrism documented in the IHS by the US Commission on Civil Rights.[15] Multiple paths to achieving Indigenous health equity exist. However, a vital component is engaging a specific Indigenous ethic based on Indigenous philosophies rather than merely referencing them. Indigenous patients of the IHS can receive more culturally sensitive and competent care if they are engaged on a cultural level. A brief hypothetical to illustrate: a non-Indigenous IHS physician requests an ethics consult to convince a patient they need surgery; the provider views this as non-maleficence (a way to avoid harm to the patient) and is frustrated with the involvement of the patient’s family and close friends in the patient’s decision to delay the surgery; the doctor views the involvement of other people as a violation of the patient’s autonomy. The Indigenous patient views the physician’s continued insistence as offensive and becomes frustrated that their decision to delay is not respected. The physician and the patient view both autonomy and non-maleficence differently. The Indigenous patient views autonomy as a fundamental interaction between oneself and one’s communities, not as a purely individual choice. The patient also does not view the physician’s actions as doing no harm, as the violation of the Indigenous worldview is causing distress to the patient. In this hypothetical, the physician could alleviate the distress by understanding the patient’s ethics. The decision to delay the operation based on community feedback is an autonomous decision of the patient who does not view the delay as a harm but as a positive, since they are patiently exploring their options and ensuring that their community is equally comfortable with the decision. In this case, the insistence that the patient violate their Indigenous pragmatism causes the harm and violation of autonomy. l. Progress and Considerations Bioethics has made important strides toward cultural competency and many programs train students in medical disciplines. While there have been significant improvements in cultural competency training and recognition, programs still do not adequately consider care of Indigenous patients,[16] and they do not sufficiently consider the complexities of Indigenous decision making. US laws privilege the Western conception of autonomy and the accompanying understanding of individualism.[17] However, these laws and frameworks do not sufficiently consider complex Indigenous nuances and communal social structures. While Indigenous patients, or their proxy, will be the one to sign off on a decision, the process still centers a Western understanding of individualism, autonomy, and body[18] that constrains Indigenous patients and often demands violation of their balanced “center good.” Resolving this conflict conceptually and in practice is not easy and will continue to require patience and the necessary involvement of Indigenous communities, bioethicists, and practitioners. CONCLUSION Indigenous philosophies often oppose traditional Western ethics employed in US healthcare. The IHS provides care to Indigenous people and could employ and further develop the use of Indigenous pragmatism and ethics. An Indigenous patient that is treated based on Indigenous philosophies and ethics can receive care and consultations that incorporate their interactions and responsibilities to their families and communities and recognize that the Indigenous patient will have a plurality of thought systems and requests based in multiple cultural contexts that may seem foreign to non-Indigenous practitioners and ethicists. The center good here demands fully incorporating Indigenous philosophies and bioethics. Failing to maintain this center good and develop explicit Indigenous ethics for all Indigenous patients—inside and out of the IHS—only serves to continue the severe healthcare inequalities experienced by Indigenous communities. - [1] Léon-Portilla, Miguel. 1963. Aztec Thought and Culture: A Study of the Ancient Nahuatl Mind. Norman, OK: University of Oklahoma Press; Pratt, Scott L. 2002. Native Pragmatism: Rethinking the Roots of American Philosophy. Bloomington, IN: Indiana University Press. [2] Ellerby, Jonathan H., John McKenzie, Stanley McKay, Gilbert J. Gariépy, Joseph M. Kaufert. 2000. “Bioethics for clinicians: 18. Aboriginal cultures”. Canadian Medical Association Journal 163(7):845-850; Cordova, V.F. 2007. How It Is: The Native American Philosophy of V.F. Cordova. Tucson, AZ: University of Arizona Press. [3] Pratt 2002 [4] Dunbar-Ortiz, Roxanne. 2014. An Indigenous Peoples' History of the United States. Boston, MA: Beacon Press; Graeber, David and David Wengrow. 2021. The Dawn of Everything: A New History of Humanity. New York, NY: Farrar, Straus and Giroux. [5] Maffie, James. 2019. “Weaving the Good Life in a Living Worl

Background:Advancing health literacy is a fundamental step toward achieving population health. To that end, the National Institutes of Health (NIH) funded research to increase scientific understanding of how health literacy can reduce disparities and enhance the health of the United States.Objective:This study identified and evaluated NIH-funded health literacy research focusing on disease prevention.Methods:New R01, R03, and R21 research project grants awarded from fiscal year (FY) 2004 to FY 2017 studying health literacy and disease prevention were identified. Study characteristics, including the role of health literacy, how health literacy was measured, populations studied, and study design, were coded for each grant. Administrative grant data were obtained from the NIH's internal database. Research impact was assessed using the relative citation ratio (RCR).Key Results:There were 192 grants studying health literacy and disease prevention awarded by 18 NIH institutes and centers from FY 2004 to FY 2017, covering a wide variety of health conditions including cancer (26.0%), infectious diseases (13.5%), nutrition (8.3%), drug/alcohol use (7.8%), and cardiovascular disease (6.3%). Most grants studied the health literacy skills of patients (88%), with a few studies assessing the health literacy practices of health care providers (2.1%) or systems (1%). There was good representation of populations with traditionally low levels of health literacy, including Black/African American participants (30.2%), Hispanic/Latinx participants (28.6%), older adults (37%), and people with low income (20.8%). The scientific articles generated by these grants were more than twice (RCR = 2.18) as influential on the field as similar articles.Conclusions:The NIH provided support for a wide array of prevention-focused health literacy research. The value of this research is highlighted by the number of funding institutes and centers, the diversity of populations and health conditions studied, and the effect these grants had on the field. Future research should move beyond patient-level health literacy to health literacy practices of health care systems and providers. [HLRP: Health Literacy Research and Practice. 2020, 4(4):e212–e223.]Plain Language Summary:This study describes health literacy research funded by the National Institutes of Health that focused on disease prevention. These grants sought to prevent a variety of health conditions, but health literacy research over the past 14 years continued to concentrate on the capacity of patients despite increased attention on the health literacy practices of health care providers and systems.

Although the Indian Health Service (IHS) has adequately stifled acute infectious diseases that once devastated American Indian and Alaska Native (AIAN) communities, this system of health provision has become obsolete in the face of chronically debilitating illnesses. Presently, AIAN communities suffer disproportionally from chronic diseases that demand adequate, long-term health maintenance such as hepatitis, renal failure, and diabetes to name a few. A number of research endeavors have sought to define this problem in the literature, but few have proposed adequate mechanisms to alleviate the disparity. The objective of this study was to examine the efficacy of both the Indian Health Service (IHS) and the relative few tribal healthcare systems (PL 93-638) respectively in their sociopolitical contexts, to determine their utility among a financially lame IHS. Domestic and international indigenous health systems were compared through analysis of the current literature on community and indigenous health. Informal interviews were carried out with indigenous practitioners, community members, and political figures to determine how AIAN communities were receiving PL 93-638 programs. Although the IHS has adequately stifled the acute infectious diseases that once devastated AIAN communities, this system of health provision has become obsolete in the face of chronically debilitating illnesses. A number of research endeavors have sought to define this problem in the literature, but few have proposed adequate mechanisms to alleviate the disparity. International indigenous health systems are noted to have a greater component of community involvement in the successful administration of health services. Reinstating notions of ownership in multiple paradigms, along with novel approaches to empowerment is requisite to creating viable solutions to the unique health circumstances in Native America. This article demonstrates the importance and need of more qualitative data to better characterize how PL 93-638 healthcare delivery is actually experienced by AIAN patients.

Pediatric Procedural Pain: How Far Have We Come? An Ethnographic Account

BackgroundIn Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique.MethodsThis exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October–November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated.ResultsOf 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed.ConclusionThis study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.

In this manuscript, I weave personal and professional stories with available literature to advocate for the necessity of decolonizing language education, taking a primary interest in the English and Spanish languages and in the Indigenous Peoples of the Americas and the Caribbean islands. Thus, I first set the stage by providing a brief historical overview of the effects caused by colonialism on the Indigenous Peoples, languages, and cultures of the Americas and the Caribbean islands. Then, I introduce my journey toward personal and professional decolonization and share practical examples of how I decolonize my teaching with the vision that this information will be helpful to readers. I end this article with final thoughts and an open invitation for further dialogue. My hope is that language (teacher) educators will use this essay as a critical reading for their language teacher pre- and in-service preparation programs and in other academic spaces.

HF02-05 A HISTORY OF HERBS USED TO TREAT URINARY TRACT INFECTION BY INDIGENOUS PEOPLE OF NORTH AMERICA

Co-Designing Change

List of Illustrations Preface A Note on Classification, Terminology, and Spelling Acknowledgements 1. Situating the Indigenous Peoples of North America 2. Studying the Indigenous Peoples of North America through the Lens of Anthropology 3. Comprehending North American Archaeology 4. Studying Population, Languages, and Cultures in North America as they were at AD 1500 5. Overview of Traditional Lifeways 6. Understanding the Colonial Experience 7. Contemporary Conditions, Nation-building, and Anthropology Epilogue: Final Comments Appendices: 1. The United Nations Declaration on the Rights of Indigenous Peoples 2. Excerpts from the Code of Ethics of the American Anthropological Association (2009) 3. Excerpts from the Native American Graves Protection and Repatriation Act (1990) 4. Excerpts from the Royal Proclamation of 1763 5. Apology for Residential Schools 6. Apology to the Native Peoples of the United States 7. Studying Indigenous Peoples of North America Glossary Bibliography Index

Toward an Indigenous Feminine Animation Aesthetic Channette Romero (bio) Indigenous women’s animated films are emerging as some of the most engaging contemporary digital media. Unfortunately, much like women’s animation in general, this growing body of work has garnered sparse critical attention. This essay seeks to call attention to the growing field and to prompt increased study of its aesthetics. Analyzing works by better-known filmmakers/artists like LeAnne Howe, Diane Obomsawin, Lisa Jackson, and Heid E. Erdrich alongside less well known filmmakers Alethea Arnaquq-Baril and Gyu Oh, I hope to highlight the range of innovation in Indigenous women’s animation, as well as its political motivations. Examining Howe’s Noble Savage Learns to Tweet (2015), Arnaquq-Baril’s Sloth (2011), Obomsawin’s Walk-in-the-Forest (2009), Oh’s I Am but a Little Woman (2010), Jackson’s The Visit (2009), and Erdrich’s Pre-Occupied (2013), I demonstrate some of the field’s most prevalent formal characteristics: frequent use of flat design, growing popularity of cutout collage animation, reclamation of Indigenous domestic arts and crafts in the digital realm, privileging of spatial relations, connective aurality, and the emergence of hybrid cinematic-literary films that attempt to contribute to real-world activism. I contend that these six aesthetic strategies are employed in an effort to raise viewers’ political consciousness in the service of Indigenous rights. Calling attention to the ways that mainstream animation’s stylistic conventions work to “naturalize” imperialism, Indigenous women’s formal experimentations with animation seek to disrupt deep-seated settler ideologies. These films blend the genre’s conventional techniques with Indigenous designs and domestic arts in an effort to assert the ongoing vitality of Indigenous women’s art and storytelling traditions. Actively situating themselves and their viewers within arts traditions that historically [End Page 56] helped humans negotiate their interdependent place within the natural world, Indigenous women’s animation shows how the digital realm is yet another of the dynamic communication networks Indigenous peoples in the Americas have long navigated with alacrity and complexity. Exploring films digitally produced and distributed, I argue that Indigenous women’s innovations in the animation genre work to bolster tribal political, cultural, and spiritual sovereignty. Increasingly cheaper digital technology has led to an exponential growth in Indigenous women’s animation, with many films digitally produced and then distributed and viewed globally online. While digital cameras, computers, and the Internet are all obviously newer technology, multimedia production is not new to Indigenous peoples; it fits within a long tradition of sophisticated communication networks. Trade routes, well traveled by Indigenous peoples in the Americas, historically utilized nonlinear designs and infographics to pass messages long distances within and between tribes. These complex informational networks joined other messaging systems like wampum belts, petroglyphs, symbols, traps, and monuments, all based on interactive mnemonics between visual design and oral storytelling. Because the messages required audience interpretation, Matt Cohen contends, “something like multimedia literacy” characterized “communications norms” (2). Cherokee scholar Angela Haas asserts that Indigenous peoples are “the first known skilled multimedia workers and intellectuals in the Americas” (78). Returning to the earliest definition of “digital” as literally referring to fingers, digits, that code information, whether in computer languages or wampum, Haas demonstrates Indigenous peoples’ “long-standing intellectual tradition of multimediated, digital rhetoric” (94).1 Mohawk-Jewish multimedia artist and scholar Steven Loft argues that Indigenous peoples “have always ‘mapped’ our environments” through storytelling and signage; multimedia has continuously functioned as “a spiritual, cosmological, and mythical ‘realm’” that “provided a direct link between the past, present, and future” (174–75, 178). While Indigenous peoples and their communication networks have obviously changed over time, their long-standing storytelling, design, and networking traditions provide a strong basis for contemporary digital multimedia. The lack of oversight online also offers a space for highly political commentary, providing a freedom of expression that might not be possible in more established filmmaking, publishing, and museum venues. As Joanna [End Page 57] Hearne notes in her introduction to this volume, “digital platforms for aesthetic production and activism, such as social media networking, low-cost independent short-form film and animation production, and web-based distribution systems, are far more available to Indigenous women...

This article examines a key element of the power relations underpinning international politics, namely coloniality. It delineates the coloniality of international politics, and elucidates the fundamental aspects of its operationalisation on the one hand, and its crystallisation into international politics on the other. The article is structured into three sections. First, it explores the meaning of coloniality, and outlines its fundamental characteristics. Next, it delineates a crucial operative element of coloniality, the idea of race, and the double movement through which coloniality is rendered operational – the colonisation of time and space. Finally, the article analyses two structuring problematisations that were fundamental to the crystallisation of coloniality in international politics – the work of Francisco de Vitoria, and the Valladolid Debate. It argues that the way in which these problematisations framed the relationship between the European Self and the ultimate Other of Western modernity – the indigenous peoples in the Americas – crystallised the pervasive role of coloniality in international politics.

Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes. A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach. Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study. A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy. This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.

Background:Influenza viruses cause annual epidemics and occasional pandemics that have claimed the lives of millions. Understanding the role of specific perceptions in motivating people to engage in precautionary behavior may help health communicators to improve their messages about outbreaks of new infectious disease generally and swine flu specifically.Objectives:To study the knowledge and practices of health care providers regarding swine flu and to study the attitudes and practices of health care providers toward the prevention of the swine flu epidemic.Materials and Methods:The present study was a cross-sectional (descriptive) study and was conducted in the month of September, 2009, among doctors and nurses. A maximum of 40% of the total health care providers of GTB Hospital were covered because of feasibility and logistics, and, therefore, the sample size was 334.Results:Around 75% of the health care providers were aware about the symptoms of swine flu. Mostly, all study subjects were aware that it is transmitted through droplet infection. Correct knowledge of the incubation period of swine flu was known to 80% of the doctors and 69% of the nurses. Knowledge about high-risk groups (contacts, travelers, health care providers) was observed among 88% of the doctors and 78.8% of the nurses. Practice of wearing mask during duty hours was observed among 82.6% of doctors and 85% of nurses, whereas of the total study population, only 40% were correctly using mask during duty hours.Conclusions:Significant gaps observed between knowledge and actual practice of the Health Care Provider regarding swine flu need to be filled by appropriate training. Data indicate that the health care providers are very intellectual, but they do not themselves practice what they preach.

Background: Children malnutrition constitutes one of the major public health problems in Egypt. Healthcare personnel lack adequate nutrition knowledge and they also lack the competence and skills to provide basic nutrition advice to their clients.Aim: To assess the knowledge, attitude and practice (KAP) of health care providers about chronic malnutrition (stunting) in children under-five in primary health care (PHC) centers and to identify the main items in which health care provides are trained including Integrated Management of Childhood Illness (IMCI) supporting the problem of stunting.Subjects and Methods: This is a cross-sectional descriptive study including all healthcare providers (N=51 doctors and 31 nurses), who were involved in the nutrition care of children under-five at PHC centers in Giza Governorate, at the time of the study. Data were collected using a structured question-naire for KAP of healthcare providers regarding chronic malnutrition (stunting) and training of healthcare providers, and using a checklist to record performance of healthcare providers providing nutrition related services to children under- five.Results: Overall, the mean percent knowledge score of healthcare providers about 'main health problems', 'main nutritional problems' and 'nutritional assessment methods' in children under five was below 50. Healthcare providers had overall positive attitude towards characteristics and manage-ment of stunting in children under-five. The mean percent score for 'Reported Practice related to breast feeding' was higher in nurses, where as reported practice related to com-plementary feeding was higher in doctors. More than 64.5% of healthcare providers reported correct practice regarding recommendation of micronutrient supplementation to children and mothers. Overall healthcare providers' performance re-garding communication and nutrition related services to children under five was suboptimal, but the nurses performing better than doctors. More than 70% of healthcare providers were trained in IMCI but there was a deficiency in nutritional training.Conclusion: The healthcare providers had optimal knowl-edge regarding some aspects of stunting. There was no signif-icant difference between doctors' and nurses' KAP in most of the items. Although they had overall positive attitude towards stunting and the majority were trained in IMCI, they showed suboptimal performance during care of children under five at PHC. The results of the study directed us to some of the recommendations as, preservice, on job and continuous prac-tical training of the health care providers on comprehensive management of malnutrition, improving the quality of health care services in PHCs and prioritizing key 1000 days window concepts in nutrition counseling for future trainings.

Objectives. To determine the knowledge, attitudes and practices (KAP) of health care providers at the Philippine General Hospital towards hypoglycemia among non-critically ill patients using a validated, self-administered survey tool.
 Methods. This study covered two phases out of a three-phased project: (1) development and validation of a 43- item KAP survey tool and (2) assessment of KAP among nurses and residents using the tool. Phases 1 and 2 are analytic cross-sectional studies. Data for the KAP survey was collected using the developed tool and focused group discussions (FGDs). Results of this study will be the framework for Phase 3, which is the development of an in-patient hypoglycemia protocol.
 Results. The validated KAP survey tool yielded a low overall mean score of 12.56 ± 2.11 in the knowledge domain although high scores (4.88 ± 1) were noted for knowledge on management of hypoglycemia. In terms of attitude, majority (99.31%) of respondents believed that fewer hypoglycemia events correlates to better clinical outcomes and are willing to adopt a nurse-driven protocol. Most respondents (52.8%) employed correct practices in hypoglycemia management. The FGDs identified the perceived facilitators and barriers to hypoglycemia management.
 Conclusion. There is a gap in knowledge and practices in managing hypoglycemia among health care providers which needs to be addressed further with education and training. Nevertheless, health care providers have a positive attitude towards having a standard hypoglycemia protocol that will contribute greatly to its implementation in the clinical area.