Mark Wieland 2/5/26 Mark Wieland 2/5/26

A Community Based Approach to Preventing Cervical Cancer

This three-phase project seeks to assess the current state of cervical cancer screening in immigrant communities, explore community knowledge and attitudes related to cervical cancer, and develop community-generated solutions to improve screening uptake. Using a mixed-methods approach, the project examines barriers and facilitators to cervical cancer screening through close collaboration with community partners, ensuring that findings reflect lived experiences and local contexts.

Guided by these insights, community and academic partners will co-design and implement educational and screening interventions. Educational materials will address the fundamentals of cervical cancer and current prevention strategies, including recommended screening and vaccination practices, and will be widely disseminated within Hispanic and Black immigrant communities in Rochester to increase awareness. In parallel, the project will evaluate the feasibility of a community-based screening intervention utilizing newly FDA-approved vaginal HPV self-collection to support screening completion and reduce access barriers.

Funding

Mayo Clinic

Mark Wieland 2/4/26 Mark Wieland 2/4/26

Examining the Impact of Stories for Change - Diabetes

Hispanic/Latinx Americans are disproportionately impacted by type 2 diabetes (T2D) due, in part, to structural factors that lead to lower physical activity levels, dietary quality, medication adherence, and glucose self-monitoring than non-Hispanic White populations. To eliminate these disparities, culturally tailored interventions that enhance acceptance of healthy behaviors and improve T2D outcomes are needed. One intervention that has the potential to be successful is digital storytelling (DST) (see Stories for Change - Diabetes). Through DST interventions, participants gain knowledge that informs behavior change which in turn enhances their healthcare outcomes and reduces illness. It is not known whether and how individual characteristics or disease type may influence how individuals respond to a tailored digital story. This project builds on Stories for Change (S4C) by evaluating how the impact of a DST intervention is influenced by sociodemographic factors such as age, gender, social support, knowledge, and T2D disease characteristics among Hispanic/Latinx populations.

We performed a secondary analysis to identify sociodemographic and disease status characteristics that influenced how participants respond to S4C. We analyzed results from S4C intervention participants (n=228), stratified by whether they experienced a clinically meaningful decrease (>0.5%) in hemoglobin A1c between baseline and three-month follow-up, and then identified factors associated with hemoglobin A1c. Participants with diabetes duration less than five years and/or whose diabetes self-efficacy improved between baseline and three-month follow-up were more likely to experience a meaningful decrease in hemoglobin A1c at three months (compared to participants without those characteristics). Next, we will interview S4C participants to further explain the results by asking participants how the factors identified did or did not contribute to their T2D-related behavior change. Finally, we will integrate our mixed methods findings to derive and visually display new insights beyond the information attained separately from the quantitative and qualitative results. These findings will allow DST interventions for Hispanic/Latinx patients with T2D to be more effectively tailored to those most likely to benefit.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (F32 DK135200)

Mark Wieland 2/4/26 Mark Wieland 2/4/26

Improving liver Cancer Health in Southeast Asian Communities: Closing the gap on liver cancer screening

Liver cancer incidence is increasing more rapidly than any other cancer in the United States, with a disproportionate burden borne by racial and ethnic minority populations. Migrants from East and Southeast Asia face particularly high risk due to chronic hepatitis B virus infection, which can lead to chronic liver inflammation, cirrhosis, and ultimately liver cancer. In the Midwest—specifically Iowa, Minnesota, and Wisconsin—liver cancer is the leading cause of cancer-related death among Asians and the third leading cause among Black populations. Across the United States, minority populations experience higher liver cancer incidence, more frequent late-stage diagnoses, lower rates of treatment, and worse overall survival. Despite established screening recommendations for high-risk individuals, screening rates remain especially low in these populations.

Preliminary interviews with Southeast Asian patients with liver cancer revealed limited awareness of asymptomatic hepatitis B infection and its associated silent risk for liver cancer. To better understand barriers to liver cancer screening and treatment across the care continuum, this project will engage patients, community leaders, and healthcare providers through in-depth interviews to identify individual-, community-, and system-level challenges. In addition, the study will examine emerging liver cancer risk factors of concern within immigrant and minority communities by assessing both biological factors (including hepatitis virus genotypes through blood testing) and modifiable behavioral factors through surveys. These assessments will be expanded to other populations experiencing high liver cancer incidence. Together, these efforts aim to identify individuals at greatest risk and inform the development of tailored, multilevel interventions to prevent liver cancer and improve outcomes in these vulnerable populations.

Funding

National Institue on Minority Health and Health Disparities (K23 MD017217-01A1)

Mayo Clinic

Mark Wieland 8/12/24 Mark Wieland 8/12/24

Through The Lens: Immigrant Perspectives on Health in Southeast Minnesota

Using Photovoice, we collaborated with Hispanic/Latino and Somali immigrant leaders to document their health-related assets and needs. The photographers’ words and photographs illustrate stories of discrimination, stress, and exclusion but also immense fortitude, resilience, and pride. Collectively, we want to ensure that immigrants have a voice in shaping the policies and decisions that impact our health and lives.

Policy makers in the United States may be unaware of immigrants’ health-related priorities due to barriers (e.g., language, voting restrictions, or exclusion from political parties). In response, Rochester Healthy Community Partnership (RHCP) collaborated with 14 Hispanic/Latino and Somali immigrant leaders in southeastern Minnesota and used Photovoice to document their health-related assets and needs.

Through a five-session workshop, leaders learned a process called Photovoice to document the health issues they see in our community. Each session included a photography lesson, group reflections, and instructions for the following session. After taking photos, the leaders reflected, discussed the issues revealed in their images, and developed policy recommendations (read recommendations here). Their words and photographs illustrate stories of discrimination, stress, and exclusion but also immense fortitude, resilience, and pride.

Collectively, we want to ensure that immigrants have a voice in shaping the policies and decisions that impact our health and lives. Leaders exhibited their photographs and shared recommendations with decision makers and the public on March 5, 2024. The public exhibit then traveled around Rochester, Minnesota between March and October 2024 to St. Mary’s University, Hawthorne Education Center, the Rochester Art Center skyway display cases, and Northrop Community Education Building.

To view the exhibit as a slide show, click on a text box or photo below. You can advance through the slideshow by clicking anywhere. You can exit the slide show by selecting the X in the upper right-hand corner.

Publications

Evaluation of a Photovoice Exhibit About Immigrant Health Priorities in Southeast Minnesota

Funding

National Institutes of Health: National Institute on Minority Health and Health Disparities (P50 MD017342)

Mayo Clinic

Mark Wieland 9/5/23 Mark Wieland 9/5/23

Mindful Hearts

In previous RHCP assessments, addressing mental health and stress has been identified as a health priority for research by community partners. Community partners acknowledge and research has shown that immigrant women face unique stressors associated with parenting, gender roles, language barriers, family separation, employment uncertainties, among others. Stress has been linked to numerous health consequences at both the mental and physical levels. RHCP partners expressed interest in developing a stress management intervention and thought that a gender-specific intervention focused on women would be helpful as the first step in this research.

To explore immigrant women's experiences with stress, their opinions about a stress management intervention, its delivery format, and whether technology-assisted interventions could be included, so that a culturally appropriate programming could be developed, focus groups among Somali, Spanish, and English-speaking immigrant women will be conducted to obtain stakeholder feedback to culturally adapt an evidence-based stress management intervention. It is anticipated that the results of this study will assist in developing and evaluating a culturally-sensitive stress management intervention prototype for immigrant women.

Funding

Mayo Clinic

Mark Wieland 2/14/23 Mark Wieland 2/14/23

Risk Communications

Crisis emergency risk communication (CERC) is the application of evidence-based principles to effectively communicate during emergencies. CERC framework is applied in public health in response to health emergencies, like the COVID-19 pandemic to encourage public participation in disease prevention and containment.

Crisis and Emergency Risk Communication (CERC) applies evidence-based principles to support effective communication during public health emergencies, such as the COVID-19 pandemic, with the goal of encouraging public participation in disease prevention and containment. Successful implementation of the CERC framework depends in part on reaching populations with histories of social injustice, health disparities, and limited access to health information. These vulnerable and minority populations often experience communication gaps related to socioeconomic disadvantage, low health literacy, immigration status, and limited English proficiency, compounded by language and cultural discordance. Community-engaged research (CEnR) partnerships are uniquely positioned to operationalize CERC frameworks in these contexts by fostering trust and ensuring messages are culturally and linguistically relevant.

RHCP developed, implemented, and evaluated a community-engaged COVID-19 CERC framework that reached thousands of individuals in Rochester and surrounding areas with timely and accurate information on COVID-19 prevention, containment, and vaccination through bidirectional communication led by trusted community communication leaders. This framework has since been adapted by other partnerships across diverse demographic and geographic settings, and RHCP is collaborating with these groups to develop a pandemic communications toolkit. The goal of this work is to synthesize the experiences of communication leaders and partner organizations into an actionable, adaptable community-engaged CERC toolkit, along with a freely available library of culturally tailored pandemic message maps and content. These resources will be made available to health departments, community organizations, and community-engaged partnerships to support effective communication during future pandemics and other public health emergencies.

Funding

Mayo Clinic: Center for Clinical and Translational Science, and Division of Public Health, Infectious Disease and Occupational Medicine

Bidirectional communication between communication leaders and community members within their social networks refined messages, leveraged resources, and advised policy makers to address COVID-19 prevention, testing, and socioeconomic impacts for vulnerable populations in Rochester, Minnesota.

Risk Communication Toolkit

Mark Wieland 12/22/22 Mark Wieland 12/22/22

Stories for Change La deteccíon temprana puede salvar vidas

Disparities exist in the screening rates for breast, cervical and colorectal cancers between Hispanic and non-Hispanic White populations. Hispanic immigrants and/or individuals who have limited-English proficiency also experience additional vulnerabilities that contribute to this disparity. Culturally tailored interventions are needed to address breast, cervical, and colorectal cancer disparities among this population.

Stories for Change: La deteccion temprana puede salvar vidas is a digital storytelling intervention aimed to improve breast, cervical, and colorectal cancer screening rates among Hispanic, Spanish speaking individuals. Storytellers from the Rochester, MN area Hispanic community were invited to participate in a storytelling workshop, facilitated by StoryCenter, to create digital stories related to their own or a loved one’s experience with breast, cervical or colorectal cancer screening.

The next phase for this project is to develop the storytelling intervention which will be pilot tested in the clinical setting.

Publications

Development of a Digital Storytelling Intervention to Increase Breast, Cervical, and Colorectal Cancer Screening in the Hispanic/Latino Community: A Qualitative Evaluation

Digital Storytelling Interventions to Promote Cancer Screening Among Hispanic/Latino Adults in Primary Care Settings

Funding

Mayo Clinic

Mark Wieland 5/13/20 Mark Wieland 5/13/20

COVID-19 Crisis and Emergency Risk Communication

Racial minorities have been disproportionately impacted by COVID-19. Moreover, vulnerable populations and minorities are more likely to have communication gaps due to socioeconomic disadvantage, low health literacy, immigration status, and limited English proficiency, compounded by language and cultural discordance and mistrust of health institutions.

Racial minorities have been disproportionately affected by COVID-19, with vulnerable populations facing heightened communication gaps due to socioeconomic disadvantage, low health literacy, immigration status, and limited English proficiency. These challenges are often compounded by language and cultural discordance and mistrust of health institutions, creating barriers to effective disease prevention and containment. To address these gaps during the COVID-19 pandemic, RHCP implemented the Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication (CERC) framework to promote bidirectional communication with vulnerable communities and support their engagement in prevention and response efforts.

Through partnerships between community and academic stakeholders, RHCP developed COVID-19 message maps focused on three core areas: prevention and containment, SARS-CoV-2 testing, and the social and economic impacts of the pandemic. Messages were delivered in six languages by bilingual community communication leaders within their existing social networks, primarily through electronic platforms such as social media, text messaging, and voice calls. These leaders also collected community health and socioeconomic concerns using the same channels, enabling iterative refinement of messaging, resource mobilization to address community needs, and timely guidance to regional decision makers. By leveraging trusted networks and community credibility, this approach demonstrates the effectiveness of community-engaged partnerships in implementing crisis and emergency risk communication for vulnerable populations during the COVID-19 pandemic.

Publications

Leveraging Community Engaged Research Partnerships for Crisis and Emergency Risk Communication to Vulnerable Populations in the COVID-19 Pandemic

Emergency Preparedness and Risk Communication Among African American Churches: Leveraging a Community-Based Participatory Research Partnership COVID-19 Initiative

The Disproportionate Impact of COVID-19 on Radical and Ethnic Minorities in the United States

Community-Engaged Bidirectional Crisis and Emergency Risk Communication with Immigrant and Refugee Populations During the Covid-19 Pandemic

Adaptation of a Bidirectional Crisis and Emergency Risk Communication Framework by Community-Engaged Research Partnerships in Rural Mississippi During the COVID-19 Pandemic

Addressing COVID-19 Inequities Using Bidirectional Crisis and Emergency Risk Communication and Vaccine Clinic Interventions: A Descriptive Study

Keeping the FAITH!: Psychosocial Factors and Healthy Lifestyle Among African-Americans During the COVID-19 Pandemic

Funding

Mayo Clinic: Community Engagement, Center for Clinical and Translational Science, and Center for Health Equity and Community Engagement Research

Nate Nordstrom 3/22/18 Nate Nordstrom 3/22/18

Social Network Analysis

In 2015, RHCP completed the Healthy Immigrant Families (HIF) project, during which community and academic partners co-created an intervention that was delivered to 44 Hispanic, Somali and Sudanese families in their homes by bilingual interventionists.

In 2015, RHCP completed the Healthy Immigrant Families (HIF) project, a community–academic partnership in which an intervention was co-created and delivered in participants’ homes by bilingual interventionists to 44 Hispanic, Somali, and Sudanese families. The intervention resulted in significant improvements in dietary quality among adults in the intervention group compared with controls. Notably, dietary improvements were also observed in the control group, suggesting the influence of a “hidden” social network effect commonly seen in behavior change interventions. These findings directly informed the development of the Healthy Immigrant Community (HIC) project, which aims to leverage existing social connections to implement a social network–based intervention to improve dietary behaviors among overweight and obese immigrant adults in Rochester, Minnesota.

The first phase of HIC involved a social network analysis (SNA) to identify community peer interventionists and examine social structures influencing health behaviors among Hispanic and Somali adults at risk for cardiovascular disease. RHCP partners completed 1,344 surveys (653 Hispanic and 691 Somali) to identify opinion leaders who could serve as interventionists and to assess associations between network characteristics and dietary behaviors. These data informed the design of a peer-delivered social network intervention targeting dietary improvement and reductions in body mass index (BMI) among overweight and obese adults. Study findings were disseminated community-wide through an event at Rochester STEM Academy, and results confirmed that obesity clusters within social networks in these communities.

Publications

Social Networks and Obesity Among Somali Immigrants and Refugees

Association of Social Network Factors with Weight Status and Weight Loss Intentions Among Hispanic Adults

Funding

Mayo Clinic: Office of Health Disparities Research
National Institutes of Health: National Heart, Lung and Blood Institute (R01 HL 111407)

Nate Nordstrom 1/18/18 Nate Nordstrom 1/18/18

Closing the Gap

Patients with Limited English Proficiency (LEP) have lower rates of cancer screening than their English-proficient counterparts in the United States. Local clinic data in Rochester, Minnesota, mirrors the national trends, with wide disparity gaps for cancer screening among patients with LEP.

Patients with Limited English Proficiency (LEP) experience lower rates of cancer screening compared to their English-proficient counterparts in the United States, a trend reflected locally in Rochester, Minnesota, where significant disparities persist in clinic-based screening rates. Addressing these gaps requires innovative, community-informed approaches tailored to the unique needs of LEP patients. The overall objective of this project is to develop a comprehensive intervention framework for cancer screening that considers patient, provider, health system, and community-level contexts. To achieve this, the first step involves rigorous qualitative research with patients and stakeholders to explore the underlying mechanisms driving screening disparities in this population. Semi-structured interviews will be conducted to (1) examine adult patients’ subjective norms, attitudes, motivations, and structural barriers affecting cancer screening in a primary care setting, and (2) capture the perspectives of non-patient stakeholders—including healthcare providers, medical interpreters, and community leaders—on potential drivers of disparities between LEP and non-LEP populations.

Findings from this qualitative inquiry, combined with practice administrative data and insights from a literature review, will inform the development of a theory-driven framework to guide future interventions aimed at reducing cancer screening disparities in LEP patients. This study represents a foundational step toward the broader goal of designing a multi-modal intervention that integrates patient, provider, health system, and community-level strategies to improve cancer screening access and outcomes among individuals with LEP.

Publications

Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities Among Patients with Limited English Proficiency

Funding

Mayo Clinic: Office of Health Disparities Research

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