Why change now? Motivational interviewing as a brief intervention for type-2 diabetes among the Eastern Shoshone and Northern Arapaho

Native Americans have the highest occurrence rates of Non-insulin dependent diabetes mellitus (NIDDM; Type-2 diabetes) of all races and ethnic groups in the United States. The Pima Indian Tribe (Tohono O'odham) of the United States has the highest incidence rate of Type-2 diabetes of any defined population in the world, with 1 in 3 people being diagnosed, with that rate climbing to 1 in 2 over the age of 45. Type-2 diabetes is a health problem of epidemic proportion in Native American communities of the United States. Secondary conditions resulting from Type-2 diabetes include kidney failure, blindness, early onset heart disease, nerve cell damage, and even death. There is abundant research on the medical aspects of Type-2 diabetes in Native American populations. This research has limitations. The majority of the research has been done within the Indian Tribes of the southwestern U.S. It overlooks addressing the prevention of complications resulting from Type-2 diabetes. Specifically, research conducted on the psychological factors in diabetes management unique to Native Americans is lacking. Research on other populations suggests that lifestyle changes such as a healthy diet, weight management, and increased exercise levels increase insulin sensitivity, resulting in better glycemic control in Type-2 diabetes. These lifestyle changes are often difficult for individuals to initiate and maintain for those diagnosed with Type-2 diabetes. Motivational Interviewing has shown positive outcomes with regard to health related behaviors, including ones related to Type-2 diabetes. This study was conducted within a population of Northern Plains Indian Tribes of the U.S., the Eastern Shoshone and Northern Arapaho tribes of the Wind River Reservation, located in west central Wyoming. Motivational Interviewing was studied as an intervention to initiate behavior change. Using the Transtheoretical Model of behavior change, readiness to adopt a healthy lifestyle was assessed. Data are lacking in the application of the Motivational Interviewing model in this population. In this study the Motivational Interviewing model and its effectiveness within this population was evaluated. Several factors were found to be predictive of change in DM patients' physiological measures and preliminary support for this intervention was demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)