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Choctaw Nation Health Services Authority
Southeastern Oklahoma
American Indian


Community Health Educators make a series of eight, hour-long home visits over the course of nine months.

To prepare for the visits, Community Health Educators receive 12 hours of interactive, workshop-based training on semi-structured interviewing techniques to help better elicit a patient’s personal and cultural understanding of diabetes—his or her beliefs about diabetes, its development and progression, treatment, preferred lifestyle changes and relationships with health care providers.

The intervention takes place in a culturally traditional area of the Choctaw Nation in the homes of tribal members with diabetes who are also patients at a clinic managed by the Choctaw Nation Health Services Authority.


Cultural beliefs may shape a patient’s understanding of diabetes in ways that conflict with the predominant medical model and therefore create a barrier to effective self-management and treatment. By tapping into a tribal value known as “anumpuli”—a true dialogue or give-and-take conversation—the approach of the Community Health Educators creates an opportunity for open communication. Learning the patient’s personal and cultural understanding of diabetes, and how it compares to the traditional medical model, allows the Community Health Educators to tailor their advice and education accordingly.

Summary Results

Culturally-trained Community Health Educators’ eight, 1-hour home visits to American Indians over the course of nine months increased patient confidence in the ability to perform diabetes self-care. However, the intervention did not decrease weight or HbA1c levels.


Principal Investigators

  • L. Carson Henderson, PhD, MPH, RN
  • J. Neil Henderson, PhD