Evaluation of a culturally tailored lifestyle intervention among Pasifika: a feasibility study

Pasifika, migrant populations from Oceania in Australia, experience high prevalence of diabetes and obesity. Lifestyle interventions targeted at weight loss have shown beneficial effects in reducing the risk of type 2 diabetes (T2DM). To identify a weight loss component for a broader lifestyle clinical trial a study testing feasibility, acceptability and sustainability of a culturally tailored lifestyle intervention was delivered in Sydney, Australia.

The study is a before-and-after single-arm feasibility study informed by a combined socio-ecological model and the newly developed Cultural and Sustainability Assessment of Intervention (CSAI) framework. Participants were adults from a Samoan church community who volunteered and provided consent. The intervention was a weight loss challenge delivered over 12-week sessions using 12 lifestyle messages targeting physical activity and healthy eating habits with an additional message on planning and tracking goals. Implementation was delivered by a peer-support and volunteer structure. The primary outcome was change in weight (kg) with secondary outcomes of change in physical activity and dietary behaviour and HbA1c, amongst others. Lead by the community, the intervention was repeated at 12-months.

There was sustained engagement in the intervention, with low attrition rates (5.2%) and low resource requirements. At baseline, n = 36/51 (71%); 34 completed pre-post measurements at 12 weeks. Significant reductions were found in primary outcomes of reduced (median difference [IQR]) weight = -3.4[6.7]kg, p = 0.01; BMI = -1.1[2.3] kg/m2, p = 0.002; and body fat (BF) = -3.5[6.9]%, p = 0.03. Secondary outcome improvements included increased physical activity (≥ 3 days vigorous exercise weekly) (χ² = 3.61, p < 0.001), and reduced sitting times (χ² = 7.69, p = 0.003). Those attending ≥ 8 sessions demonstrated greater overall changes in clinical outcomes. At 12-months, a repeat of the intervention resulted in mean 4.8 kg (SD ± 6.05), p = 0.002 weight loss. Community reported acceptance of the tailored intervention as culturally relevant with the support structure as crucial for implementation.

Results of this single-armed study indicate feasibility of the 12-week competition-based WLC to elicit weight loss in a minority population, such as Pasifika. Community response attested to acceptance and viability of the support structure. Opportunities exist to revise materials and use the CSAI to design culturally appropriate and tailored interventions to better engage Pasifika and minority populations.