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cardiovascular disease, diabetes, Pacific Islanders, perceived risk



  1. Siaki, Leilani A. PhD, FNP-BC
  2. Loescher, Lois J. PhD
  3. Ritter, Leslie PhD


Background: Cardiovascular disease (CVD) and diabetes, which are leading causes of morbidity and mortality in the United States, have a high incidence among Pacific Islanders. Risk of these conditions increases in the presence of metabolic syndrome. Risk-reducing behaviors for CVD and diabetes are driven partly by perceived risk of health threats and their consequences. Perceived risk is influenced by sociocultural beliefs and is a component of some health behavior models, yet it is understudied in Pacific Islanders.


Objective: This mixed-methods study explored the perceived risk of CVD and diabetes in at-risk Samoan Pacific Islanders.


Subjects and Methods: We used culturally sensitive strategies to recruit and enroll 43 adult Samoans from a community setting in Hawaii. Participants were obese with at least 1 other component of metabolic syndrome. Their objective risk was determined by the National Cholesterol Education Program Adult Treatment Program III risk categories. Participants provided demographic and health history information and answered 2 quantitative perceived risk questions. They also participated in 1 of 7 focus groups-the source of perceived risk qualitative data. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis, respectively. The mixed-methods analysis targeted points of data convergence and complementarity for the 2 methods.


Results: More than 80% of participants who were at moderately high (10%-20%) objective risk for CVD and diabetes had high (>20%) perceived risk of these conditions. There was high concordance of perceived risk for CVD and diabetes (P < .05). Qualitative data revealed bidirectional codes that influenced and were influenced by perceived risk within the participants' cultural perspective: current and planned health behavior, physical health, and family history of CVD or diabetes.


Conclusion: Using mixed methods facilitated better understanding of cultural perspectives of perceived risk of CVD and diabetes. These results provide a foundation for developing culturally appropriate interventions targeting CVD and diabetes risk reduction in Samoans.