摘要：Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings. Translating efficacious health treatments into routine clinical and public health practice to eliminate health disparities for communities at risk is an increasing public health priority. Recent significant advances in diabetes care have the potential to prevent complications from diabetes and improve quality of life, yet these evidence-based practices are not being used in real-world settings. 1 , 2 Innovations from other cultures or from efficacy studies in academic settings may be ineffective in low-income, minority, or ethnic communities. This is attributable to barriers to care, such as limited access, health worker shortages, underfinanced health systems, and cultural and language factors, among many challenges. 3 As a result, new research frameworks are emerging to help guide the adaptation process. One such framework is translation research: applied research to help understand solutions to real-world health care delivery problems and to learn about transferability of solutions to diverse settings, while retaining effectiveness, efficiency, and sustainability. 4 Another approach is implementation science, which describes the process of bridging health disparity gaps in developing countries; it also aims to create a knowledge base that can be applied across real-world settings to answer key research questions, such as how proven clinical interventions should be modified to achieve sustained health improvements. 3 Both of these approaches advocate for exploration of advances in theoretical models, new methods, multilevel interventions, and multidisciplinary collaborations to accommodate different contexts. 3 , 4 Diabetes rates are increasing in the United States and throughout the world, where 80% of people with diabetes live in low- and middle-income countries. 5 Recent diabetes care advances need to be introduced in these communities, including the US territory of American Samoa, where the prevalence of type 2 diabetes in adults aged 18 years or older is 21.5%, 6 double the 2007 US rate of 10.7% for adults aged 20 years and older. 7 The Centers for Disease Control and Prevention launched an extensive process to build and train community coalitions to address diabetes in the Pacific Islands—including American Samoa—from 1998 to 2003, 8 – 10 thus beginning to build an infrastructure to support diabetes interventions. Several descriptive reports of observational diabetes interventions among other Pacific Islanders have been published, 11 – 13 as well as some comparison group studies among Samoans in New Zealand 14 , 15 and Pacific Islanders in the Torres Strait Islands near Australia. 16 , 17 However, no randomized controlled intervention trials among American Samoans have been conducted; studies with such a design would strengthen the science of translation. The process of cultural adaptation brings yet another dimension to translation research, and this integrated process is termed cultural translation. We discuss our experience with cultural translation prior to and during our study, Diabetes Care in American Samoa (2004–2010). This intervention employs a primary care–based team comprising a nurse and 4 community health workers to support diabetes self-management. We describe our process of choosing an intervention approach from evidence-based models, our community partnerships, and our use of formative research and applied adaptations to design a randomized trial to test the effectiveness of the intervention in the Samoan setting. We also discuss challenges to the translation and solutions we developed, which may inform adaptations of interventions in other settings.
