Feasibility
Qualitative results provided insight into recruitment and retention issues and the organization and implementation of the pilot.
Retention was facilitated by trust in the CHW, and assistance provided in accessing resources, such as translation or external linkages to health services and public insurance, both for participants and their friends.
Several challenges to recruitment and retention emerged, including low-turn out at screening events and difficulty scheduling screening events at community churches with busy programmatic schedules; extended travel by participants to Korea during the intervention period; and difficulty scheduling education sessions and data collection meetings.
In addition, community members often believed that if they did not have symptoms of diabetes, they did not need to take steps to prevent the disease, particularly if they had insurance and a primary care physician.
For example, the CHW provided: ‘‘Prevention is not important in the culture… unless they really want to be healthy or unless they have a family member with the disease.’’
One focus group participant shared: ‘‘I haven’t referred back to the hand-outs [given out at each education session] because currently I’m not sick and not diagnosed with anything.’’
The CHW also acknowledged that some participants may not be intrinsically motivated to attend sessions, but may attend ‘‘because they don’t want to let [her] down.’’
Participants would say: ‘‘you work so hard’’ and ‘‘I know it helps you,’’ demonstrating that motivators to participation may involve unique cultural components of a sense of obligation or guilt.
It was also challenging to schedule meetings to collect survey questionnaires and clinical measurements in addition to the six group sessions.
Participants with busy schedules and family obligations reported irritation with the length of surveys and sessions, as well as with the number of follow-up phone calls and goal-setting exercises.
The CHW also agreed that goalsetting exercises were challenging for participants, who often asked her to assign them goals rather than develop their own personal goals.
In regards to intervention organization and implementation, facilitators included hosting sessions in community locations convenient for participants, during weekends, and