Numerous studies have shown the importance of a community health network in diabetes self-care and in making health interventions in Native American communities. There is also considerable support for the efficacy of exercise in preventing diabetes complications provided that the exercise is administered in a culturally appropriate way. Native American perceptions of diabetes, and care seeking have both been shown to be flexible and to benefit from a community based approach to healthcare. While research in the area is relatively sparse, most articles suggest that a community based and culturally appropriate approach is the best way to manage diabetes in a Native American community.
Our underlying proposal is that a tribe is a large social network and that we can use that social network to change behaviors. Berkman (see figure) has labelled this type of social network intervention a social influence model to indicate that we will use properties of the social network to engage its members in desired behaviors, in this case increasing exercise, healthy lifestyle choices and diabetes control among previously diagnosed patients.
buddy support programs, where lay people are recruited and trained to help others with the same condition, have been used successfully to improve medication adherence and adherence to behavioral regimens for HIV patients, with the rationales that clinical adherence services do not extend to daily life, where patients need support the most, and that peers can understand the difficulties and possible solutions. Buddy support has been evaluated previously as a strategy for improving diabetes control, but not among Native people and not in a tribal setting. Dr. Jane Simoni has provided us with protocols and training materials from her research program on buddy systems to promote adherence to complex medical regimens. Most peer/ buddy interventions contain common core components: a training program for buddies, a protocol for contact with the participants that need buddy support, and ongoing support of the buddies from more experienced clinicians and medical and health staff.