An Examination of the Socio-Ecologic Factors Associated with Diabetes Status in Palau Open Access

Farr, Mikayla (Spring 2018)

Permanent URL:


Introduction: Type 2 diabetes accounts for 90% of all diabetes cases worldwide. The epidemic of Type 2 diabetes is particularly severe in Palau, one of the six U.S. Affiliated Pacific Islands (USAPIs). The current study uses data from the 2016 Palau Hybrid Survey to understand the relationship between multiple levels of the Socio-Ecologic Model and two diabetes outcome measures: diabetes status and diabetes diagnosis status. Specifically, the following question was used to guide the current research study: To what extent are socio-ecologic factors associated with diabetes indicators in the Palau Hybrid Survey?

Methods: The Palau Hybrid Survey is a population-based survey conducted from May - December 2016. The survey combined self-reported risk factors with physical and biochemical measurements to determine the risk and prevalence of NCDs. A total of 1671 individuals were included in analyses for the current study. Two multivariate logistic regression models were performed to ascertain the effects of selected variables on the two outcome measures in Palau. Permission to conduct this secondary analysis was sought from the Palau Institutional Review Board in March 2018.

Results: Results of the diabetes regression model suggest that older age, self-rated health fair or poor health, obese BMI, and hypertension are significant predictors of diabetes in Palau. Overall, the model was statistically significant and explained 12.8% (Nagelkerke R2) of the variance in diabetes (χ2(14)=118.60, p <.001). Results of the diabetes diagnosis regression model suggest that age, gender, ethnicity, sugar sweetened beverage consumption, and annual health exam are significant predictors of diabetes diagnoses in Palau. The model was statistically significant and explained 23.1% of the variance in diabetes diagnosis (χ2(14)=56.65, p <.001).

Discussion: Our data indicate the diabetes prevalence in Palau to be about 20%. Most alarmingly, 65% of diabetics in Palau are undiagnosed. Overall, findings were consistent with previous research, indicating that individuals living in Palau have similar risk factors for diabetes. However, the high percentage of undiagnosed diabetics in Palau is cause for concern. Public health practitioners should encourage the population to visit a primary healthcare provider for diabetes screening and treatment.

Table of Contents

Table of Contents Chapter 1. Introduction 1 Background 1 Regional Context – U.S. Affiliated Pacific Islands 2 Community Context – Republic of Palau 3 Justification of Current Project 8 Socio-Ecologic Model 9 Formal Statement of the Problem 10 Chapter 2. Literature Review 12 Intrapersonal Factors 12 Institutional Factors 17 Community Factors 19 Policy Factors 21 Chapter 3. Methods 23 Overview of Current Study 23 Study Population/Participants 23 Data Collection 24 Measures 25 Outcome Variables 25 Intrapersonal-Level Variables 26 Institutional-Level Variables 30 Community-Level Variables 31 Statistical Analysis 32 Ethics Approval 32 Chapter 4. Results 33 Study Sample 33 Bivariate Results 33 Intrapersonal-Level Variables 33 Community-Level Variables 36 Institutional-Level Variables 36 Diabetes Regression Model 37 Diabetes Diagnosis Regression Model 39 Chapter 5. Discussion 41 Comparison with Other Studies 41 Strengths and Limitations 44 Conclusions 45 Appendices 46 References 57

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Partnering Agencies
Last modified

Primary PDF

Supplemental Files