Effective engagement in care is essential to reduce the physiological, economic, and social burden of high Type 2 Diabetes (T2D) prevalence in the Pacific Islands and Pacific Islander communities globally. In Samoa specifically, T2D prevalence has increased rapidly within the past 30 years. However, prior work indicates major losses and gaps within non-communicable disease (NCD) care cascades (i.e., at screening, diagnosis, treatment, and control). The reasons for these losses remain understudied. This project will use innovative methods to comprehensively assess diabetes care experiences, and establish the formative data necessary to reduce cascade gaps, and construct evidence-based, patient centered and sustainable diabetes interventions and treatment strategies.

We recruited n = 450 adult Samoans living with diabetes (< 24 months) for baseline assessments. Approximately half of the participants (n = 220) are being followed prospectively; additional data will be collected at 12-month and 24-month post baseline assessment. We are measuring (1) diabetes care preferences through Discrete Choice Experiments (specialized surveys), and diabetes-related perceptions, outcomes, and risk factors (via questionnaires and anthropometrics) among n = 450 participants; (2) changes in glycemia, risk factors, care preferences, and diabetes-related outcomes among n = 220 participants; and (3) identifying and understanding changes in disease experiences, illness identities, and coping strategies among n = 13 participants via interviews using a longitudinal interpretative phenomenological analysis approach. With these new data, we will be able to identify when, and how, individuals are adapting to their treatment programs, and what strategies may facilitate sustained engagement in care over time.

This study will help to identify the most impactful targets and timing for future diabetes care interventions in this setting. The interdisciplinary and mixed methods approaches used, will help to illuminate patient-centered care strategies, improve implementation outcomes, and provide patient and policy relevant data useful for constructing efficacious, and cost-effective treatment programs. This study will help us better understand diabetes experiences in the Pacific, and may be impactful for Pacific Islanders throughout the diaspora.