Mediators of Lifestyle Behavior Change in Native Hawaiians

Initial findings from the Native Hawaiian Diabetes Intervention Program

  1. Marjorie K. Mau, MD12,
  2. Karen Glanz, PHD3,
  3. Richard Severino, MS4,
  4. John S. Grove, PHD5,
  5. Bruce Johnson, BSN2 and
  6. J. David Curb, MD12
  1. 1John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
  2. 2Research Centers for Minorities Institution, University of Hawaii, Honolulu, Hawaii
  3. 3Cancer Research Center of Hawaii, University of Hawaii, Honolulu, Hawaii
  4. 4Queens Medical Center, Honolulu, Hawaii
  5. 5School of Public Health, University of Hawaii, Honolulu, Hawaii


    OBJECTIVE—To examine the association of stage of change with diet and exercise behaviors in response to a lifestyle intervention for Native Hawaiians (NHs).

    RESEARCH DESIGN AND METHODS—A family (‘ohana) support lifestyle intervention was compared with a standard intervention in NHs with or at risk for diabetes in two rural communities in Hawaii (n = 147). Stage of change, as a hypothesized mediator of behavior change, and dietary and exercise behaviors were measured at baseline and at 1 year postintervention.

    RESULTS—Stage of change was significantly associated with positive dietary and exercise behaviors. NHs receiving the ‘ohana support (OS) intervention were more likely to advance from pre-action to action/maintenance for fat intake and physical activity than the group who received the standard intervention. Participants in the OS group who advanced from pre-action to action/maintenance showed more improvement in fat intake and physical activity than those in the standard group.

    CONCLUSIONS—These initial findings suggest that stage of change is an important factor in mediating lifestyle behavior changes in persons with or at risk for diabetes and merits further study among minority populations at high risk for diabetes.


    • Address correspondence and reprint requests to Marjorie K. Mau, MD, University of Hawaii, John A. Burns School of Medicine, Department of Medicine; 1356 Lusitana Street, 7th Floor, Honolulu, HI 96813. E-mail: mmau{at}

      Received for publication 19 October 2000 and accepted in revised form 19 June 2001.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

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