Abstract P140: Using Group Model-Building to Understand and Address Type 2 Diabetes in Native Hawaiian Communities

Abstract

Introduction: Native Hawaiians, the indigenous people of Hawai‘i, have a prevalence of type 2 diabetes more than twice that of non-Hispanic Whites. Risk factors and social determinants of health for type 2 diabetes are multilevel and interrelated including individual-level factors, household-level, community-level, and societal-level. To address this complex issue effectively, it is crucial to understand the structure of how these factors interrelate and result in prevalence of type 2 diabetes in Native Hawaiian communities. Group Model-Building (GMB) is a participatory method rooted in systems theory, which provides a conceptual framework to understand such complex systems. It engages stakeholders in a structured process that leverages local knowledge to create contextually relevant causal loop diagrams (CLDs).Purpose: To demonstrate the value of GMB in constructing a CLD that captures the relationships and feedback mechanisms underlying type 2 diabetes in a Hawaiian homestead region and identify potential targeted interventions and policies to address type 2 diabetes prevalence, morbidity and mortality. Methods: Prior to the GMB workshops, we identified and engaged key homestead stakeholders, aquired necessary materials, selected a meeting location, create and train a facilitation team, and create the GMB agenda. The workshops were held over two evenings and included structured activities: Hopes and Fears, Graphs over Time, Causal Loop Diagrams, and Action Ideas. Results: Hopes and fears themes included: decreasing prevalence, healing, health education, community programs, decreasing quality of life, death, and the impact on the family spectrum. Graphs over time depicted increases in behavioral risk factors for type 2 diabetes, increases in type 2 diabetes-related morbidity, changing access to care, and changing quality of life. Participants developed and revised a CLD illustrating balancing and reinforcing feedback structures. Finally, participants developed 13 intervention/program ideas to address type 2 diabetes including health-related policies, community programs, and addressing social determinants of health (eg., access to care and healthy food, employment services). Conclusion: GMB was seen as a valuable tool for visualizing the connections and interdependencies between factors which community understands intuitively but hasn’t seen represented on paper. The process revealed the extent to which community programs impact community members, and highlighted collaborations to foster to sustain these effects. The constraints of physical space limiting the programs they can offer were identified. GMB is a promising method for collaboration, knowledge sharing, and co-creating a comprehensive understanding of diabetes-related factors in Native Hawaiian communities.