AHRQ Guides Help American Samoa Boost Preventive Efforts

When the Department of Health in American Samoa opened its first Community Health Center in Pago Pago, the Center directors turned to AHRQ for assistance. AHRQ's Putting Prevention Into Practice (PPIP) seminars and patient education products helped improve the quality of preventive care delivered to the local community.

"For our first federally funded Community Health Center, we wanted to start out with the principles of PPIP. After attending a PPIP conference in Austin, Texas, it was obvious that a key part of the initiative is patient education," comments Charles (Mick) McCuddin, MPH, Department of Health (DoH), American Samoa.

Through AHRQ's Publishing Clearinghouse, the Community Health Center received 1,600 copies of the Pocket Guide to Good Health for Adults and the Pocket Guide to Staying Healthy at 50+. Now, many years later, the initial supply is gone, but the organizers of the Community Health Center translated the PPIP guides into the Samoan language. Then, using a small grant from the Bureau of Primary Health Care, they locally produced the PPIP guides and continue to distribute them to patients.

"We cannot quantify the effect of the patient education materials, but observationally, the impact is clear. Traditionally, patients were timid in the clinical encounter, true to the paternalistic model of patient care. However, armed with the PPIP guides, patients now ask questions, engage in the health care decision-making, and want to know about proactive steps and preventive measures they can take," reports McCuddin.

Much like the continental US, the Samoan community faces obesity, hypertension, and diabetes. The Community Health Center, serving a quarter of the territorial population with approximately 2,000 patient encounters a month, was built as part of a demonstration project to show a superior model of delivering health care through primary care practice.

Previously, much of the territory was served by small, immunization-only, public health-model clinics and a government-owned hospital. The DoH now hopes to build community health care centers to offer primary care to the entire population, thus improving the quality of care, particularly for preventable and chronic diseases, and reducing overall health care expenditures.

A U.S. territory since 1900, American Samoa is a group of six Polynesian islands in the southern Pacific, representing the United States' southernmost territory at 14 degrees below the equator. The territory, approximately the size of Washington, DC, has a population of 57,794 people with a median age of 23.2 years. Ninety percent of the population speaks the native Samoan language, and literacy rates approach 100 percent in the population over 15 years of age.

The American Samoa DoH has offered the Samoan translation of the PPIP guides to providers in the United States who serve Samoan patients. Those interested should contact Charles McCuddin, MPH, PHEP Director, Department of Health, American Samoa Government, Pago Pago, AS 96799; (684) 699-4981; cmccuddin@hotmail.com.