Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands

Formative research was conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two mai n conceptual spheres: foods from the islands/Marshallese foods and imported /American foods. Diabetes (nanimij in tonal) is a highly salient illness an d is believed to be caused by foods high in fat and sugar, consumption of i mported/American foods, fan-Lily back.-round, and the atomic bomb testing, Physical activity and eating a traditional diet were viewed as important fo r preventing diabetes. The traditional belief system links a large body wit h health, and a thin body with illness; however, perceptions are changing w ith increased acculturation and education about the health risks of obesity . These findings were used to develop a diabetes prevention home visit inte rvention currently being implemented and evaluated in Marshallese household s.