Table 1.

Hawaii Modifications to the Chronic Disease Self-Management Program (CDSMP)

Modification	Light grading	Description
Giving the program a local name and bamboo logo	Green	Name was changed from CDSMP to Ke Ola Pono, which means “health in balance” in Hawaiian. Bamboo is a commonly known Asian symbol of longevity. Both were included in marketing materials.
Creating and delivering a recruitment presentation	Green	This presentation helped to familiarize elders with the concept of self-management, orient elders to program requirements and expectations, introduce leaders for the workshop, and create trust in discussing personal health issues.
Opening sessions with prayer	Green	Opening sessions with prayer is expected in some cultural groups, especially Native Hawaiians.
Providing healthy local food after each session	Green	Serving healthy food using local fresh fruits and vegetables has cultural meaning that promotes socialization.
Providing certificate for completion	Green	Leaders and officials signed the certificate, awarded at the end of the workshop. This activity increased motivation for program completion.
Adding “Session 0” to provide assistance to complete forms	Yellow	Group leaders provided one-on-one support to complete consent and registration forms and baseline questionnaires. This helped to overcome health literacy and vision barriers.
Adding 6-month reunion for graduates	Yellow	This activity provides opportunity to share successes and to collect 6-month follow-up data.
Adding opportunities to explain terms and clarify concepts using local examples	Yellow	Leaders reviewed content using their native language outside of class time so that program participants could learn English words related to self-management. Local examples were used to enhance understanding.
Training leaders to prepare the group members to be mindful of time limits and the need to hear from all participants	Yellow	Asking an elder to stop talking is not a familiar practice, especially when the leader is younger than the elder. Training leaders to prepare their groups for this enhanced acceptance of the program.