Meeting People Where They Are: A Community Health Center’s Approach to Lifestyle Medicine
Medical students from A.T. Still School of Osteopathic Medicine collaborated with Kent, Washington’s Pacific Islander community to improve their health through culturally sensitive dietary changes, resulting in a 67% increase in vegetable and fruit consumption and 83% positive feedback on dietary choices and education.
An Article Written by: Ruth Michaelis, MD, DipABLM, FAIHM
Each year, our Community Health Center’s (CHC) embedded osteopathic medical students from A.T. Still School of Osteopathic Medicine in Mesa, Arizona, work with CHCs across the country to address health-related issues impacting historically medically underserved communities. At any given year, Health Point, the clinic that I’ve worked at for the last 21 years, hosts up to 30 medical students from A.T. Still.
This year, the third-year medical students placed at our clinic chose to work with the local Pacific Islander community near our Kent, Washington, Community Health Center after data from our clinic showed that these patients had higher hemoglobin A1c (HbA1c) levels than other patients. Pacific Islanders represent five percent of my clinic’s patient population, yet nearly 10 percent of those patients have been diagnosed with diabetes.
Our medical students wanted to learn more about this unique patient population as a way to inform a strategy to help them make healthier lifestyle changes. Starting with a visit to a Pacific Islander neighborhood grocery store, they got first-hand accounts of this ethnic group’s preference when it came to traditional ingredients.
“To effectively connect with a community, it’s essential to immerse within culturally resonant dietary options while placing emphasis on patient autonomy,” said Adam Martorana, A.T. Still School of Osteopathic Medicine medical student. “This creates a powerful tool for empowering individuals within the population, driving lasting and meaningful change.”
In addition, Martorana and the other rising physicians met with local church leaders to find out more about culturally relevant recipes and the community needs around health and nutrition. There were several emerging themes, but the dominant one was the notion around honoring what individuals from the Pacific Islander community consider to be “traditional foods.”
Lifestyle medicine can address up to 80% of chronic diseases. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Undoubtedly, food and nutrition are gamechangers when it comes to treating diabetes and lowering HbA1c levels. The nutritional aspect coupled with the other pillars of lifestyle medicine—physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections—are also effective in treating cardiovascular diseases and obesity.
When working with historically medically underserved groups, who are at a higher risk for lifestyle-related chronic disease, it is important to understand their cultural norms and how to work within those means to make realistic nutritional plans and adaptations to their diets. That said, the medical students decided to adapt traditional recipes to incorporate many of the same foods (even meat) and with a healthier ingredient list.
They cooked the foods, taste-tested them, and offered the meals to the community, for free, after a church service. There, they gathered more feedback about the food and created modified recipes for breakfast, lunch, dinner, and even snacks. We created handouts of the recipes and a healthy food flyer that were available for congregants.
When the students called the patients a few weeks later, they found their daily reported consumption of vegetables and fruits increased by 67%. Additionally, half of respondents started or increased the practice of measuring food portions, and 83% stated the provided information helped them improve dietary choices and interested them in further education.
Seeing this project come full circle, I am proud to serve as advisor for our medical students, who set out to better understand the patient population and launch a pilot that would put their cultural values first. We see from the data that pilots like this one have great potential because they’re created with realistic goals and in observance of and respect for cultural differences—a cornerstone of cultural competence.
“Normally, we are told what to change in our diets and lifestyles, which usually requires getting rid of our culture,” said a participant from the pilot. “Providing education and being willing to help us make smarter choices, while not changing our culture, opens up a lot more options and willingness from our community.”