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.

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: Stress Intervention for Women

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. Effective application of CERC framework depends, in part, on reaching populations with a history of social injustice, health disparities, and limited access to health information. These vulnerable populations and minority groups 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.

Community-engaged research (CEnR) partnerships are uniquely positioned to operationalize pandemic risk communication frameworks among vulnerable populations. Community-engaged CERC has the potential to reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community voices in regional pandemic mitigation policies.

RHCP developed, implemented, and tested a community-engaged COVID-19 CERC framework, through which thousands of people in the Rochester and surrounding areas were reached with accurate and timely information on COVID-19 prevention, containment and vaccination. This framework, which included bi-directional communication through communication leaders, was adapted by other partnerships in a variety of demographic and geographic contexts. RHCP is collaborating with other community-engaged partnerships that used the RHCP CERC framework to create a pandemic communications toolkit.

The goal of this work is to harness the experiences of the communication leaders and others who used the RHCP CERC framework, to develop an actionable toolkit of community-engaged CERC that can be adapted for the current and future pandemics in diverse contexts. This toolkit, as well as a freely available culturally tailored pandemic message library with message maps and message content may be adapted for future use, will be freely available for use by health departments, community organizations and community-engaged partnerships during future infectious disease outbreaks and other public health related emergencies.

Funding

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

project deep-dive:
risk communication

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.

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. To encourage participation in disease prevention and containment by these populations, RHCP implemented the Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication (CERC) framework to promote bidirectional crisis and emergency risk communication to vulnerable populations for the COVID-19 pandemic.

COVID-19 message maps were developed by RHCP community and academic partners. Message content focused on three constructs: COVID-19 prevention and containment; SARS Coronavirus-2 testing; and, social and economic impacts of COVID-19. Messages in six languages were delivered by bilingual communication leaders within their social networks. Messages were mostly delivered electronically, e.g., social media, text messaging and voice calls. Communication leaders solicited community health and socioeconomic concerns through the same platforms. This bidirectional communication with community members was used to enhance subsequent messaging, leverage resources to meet community needs, and advise regional decision makers. By leveraging existing networks and credibility, community-engaged research partnerships may effectively implement crisis and emergency risk communication to vulnerable populations in 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. Results showed significant improvements in dietary quality for adults in the intervention arm compared with controls. There was also improvement in the control group, suggesting the presence of a “hidden” social network effect common to behavior change interventions. This led to the conception of the Healthy Immigrant Community (HIC) project. The overall objective of HIC is to use these existing connections to implement a social network intervention aimed at improving dietary behaviors among immigrant adults who are overweight and obese in Rochester, Minnesota.

The first phase of HIC is a social network analysis (SNA) to identify community peer interventionists and assess existing social structures that contribute to health behaviors among Hispanic and Somali adults at risk for cardiovascular disease. RHCP partners completed 1,344 (653 Hispanic, 691 Somali) surveys to identify opinion leaders who may be recruited as interventionists, and to understand the association between network characteristics and dietary behavior to inform the development of the peer-delivered social network intervention to improve dietary behaviors and reduce body mass index (BMI) among adults who are overweight or obese. Community-wide dissemination of study results was accomplished through a community event at Rochester STEM Academy.

Results confirmed that obesity clusters by social networks in these communities.

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.

The overall objective of this project is to develop an intervention framework for cancer screening among people with LEP that incorporates patient, provider, health system, and community level contexts. The first step in this project is to conduct rigorous qualitative research with patients and stakeholders in order to understand the mechanistic underpinnings of screening disparities for this unique group of patients. Semi-structured interviews will be conducted to: 1) identify subjective norms, attitudes, motivations, and structural factors that affect cancer screening among adult patients with LEP in a primary care practice, and, 2) identify non-patient stakeholders’ (healthcare providers, medical interpreters, and community leaders) perspectives on potential mechanisms for cancer screening disparities between LEP and non-LEP populations.

The results of this qualitative inquiry, together with available practice administrative data and the results of a literature review, will be used to develop a theory-driven framework to inform future interventions to reduce practice-based cancer screening disparities among patients with LEP. This study represents the foundational step toward the overall objective of future work: developing a multi-modal intervention that incorporates patient, provider, health system, and community level contexts to address cancer screening disparities among patients with LEP.

Funding

Mayo Clinic: Office of Health Disparities Research

Nate Nordstrom 7/29/17 Nate Nordstrom 7/29/17

Stories for Change (S4C) Diabetes

Racial and ethnic minorities in the United States, including immigrants and refugees, have higher rates of diabetes, and worse outcomes than the general population. Stories told by people who live successfully with diabetes may improve the health of people who are having difficulty living with diabetes.

Stories for Change Diabetes is multi-phase project using a digital storytelling intervention aimed at improving diabetes management among Hispanic and Somali immigrants and refugees with type 2 diabetes. Phase 1 included development and deployment of a culturally and linguistically appropriate interview-based survey, in order to understand diabetes-related attitudes, knowledge and health-seeking behaviors among Hispanic and Somali adults with diabetes. Results from the survey were used to develop a focus group facilitation guide which was used in Phase 2. Focus group attendees included a subset of survey participants who were invited in order to learn more about their lived experiences with diabetes management. Transcripts from the focus groups were analyzed and emergent themes were used to inform the next phase. During Phase 3, a storytelling guide was developed. Eight participants were invited to share stories that centered on themes related to successful culturally relevant strategies for medication management, glucose self-monitoring, physical activity, and nutrition for diabetes. The study team worked with the Center for Digital Storytelling to develop and record eight digital stories during a multiday workshop. Phase 4 was a pilot feasibility project to test screening and enrollment processes and examine the potential effectiveness of these digital stories among 25 participants in five different clinical sites (four in Minnesota and one in Arizona). Participants found the stories to be interesting, attention-getting and useful. Implementation processes of this intervention in the clinical settings were streamlined. The intervention resulted in self-rated improvement in psychosocial constructs associated with healthy diabetes self-management behaviors, and some evidence of improvement in glycemic control.

In the current phase, RHCP is evaluating the effectiveness of these digitally recorded stories in improving health outcomes among Hispanic adults with diabetes, through a multi-site randomized clinical trial with partners at Mountain Park Health Center in Phoenix, AZ and Hennepin Healthcare in Minneapolis, MN. The study has enrolled and completed measurements on 455 participants. Data analysis is currently ongoing.

In addition, RHCP is evaluating the effectiveness of these digitally recorded stories in improving health outcomes among Somali adults with diabetes, through a randomized clinical trial in Rochester, MN.

Funding

Mayo Clinic: Values Council, Office of Health Disparities Research, and Center for Clinical and Translational Science
George Family Foundation: Catalyst Award

National Institutes of Health: National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 113999)

Materials

Stories for Change - Spanish

Stories for Change - Somali

Nate Nordstrom 7/29/17 Nate Nordstrom 7/29/17

Healthy Immigrant Community

While immigrant and refugee populations arrive to the United States healthier than the general population, these advantages disappear over time, partly due to adoption of unhealthy dietary behaviors.

While immigrant and refugee populations arrive to the United States healthier than the general population, these advantages disappear over time, partly due to adoption of unhealthy dietary behaviors. Population-based interventions have largely proven ineffective in maintaining previously healthy behaviors and novel approaches tailored for and initiated by these communities are needed.

In 2011, RHCP received funding for the Healthy Immigrant Families (HIF) project, during which community and academic partners co-created an intervention of 12 face-to-face lessons on healthy eating and physical activity delivered to families in their homes by bilingual interventionists. At 12 months, there were significant improvements in dietary quality for adults compared with controls. There was also improvement in the control group. This led to the conception of the Healthy Immigrant Community (HIC) project. The overall objective of HIC is to modify our HIF program to implement a social network intervention to improve dietary behaviors among immigrant adults who are overweight and obese in Rochester, Minnesota. We intend to capitalize on the social network effects by expanding our theoretical framework to address the influence of a broader social context on behavior change while enhancing the potential reach and sustainability of the intervention.

In February 2020, RHCP initiated a pilot study in Rochester, Minnesota in which 12 face-to-face lessons taught by Mayo Clinic experts on healthy eating and physical activity are delivered to Hispanic and Somali adults designated as Health Promoters. The Health Promoters then deliver the same lesson to their respective social network of five to 10 individuals.

In June 2022, RHCP enrolled 475 individuals to a randomized clinical trial in Rochester, Minnesota. Health Promoters are receiving training from Health Coaches and are facilitating face-to-face or virtual group sessions with their social networks over 12 months. Each session will target specific aspects of healthy eating and physical activity.

Funding

National Institutes of Health: National Heart, Lung and Blood Institute (R01 HL 111407) Mayo Clinic Center for Clinical and Translational Science: National Center for Advancing Translational Science UL1 TR000135 Mayo Clinic Office of Health Disparities Research National Institutes of Health: National Institute on Minority Health and Health Disparities (P50 MD017342)

Nate Nordstrom 7/28/17 Nate Nordstrom 7/28/17

Healthy Immigrant Families

Immigrants and refugees arrive to the United States healthier than the general population. But, the longer they live in the U.S., the more likely they are to approximate the cardiovascular risk profiles of the general population, including increased rates of obesity, high blood pressure, high cholesterol, diabetes, and heart disease. Two reasons for the development of these diseases are low levels of physical activity and lack of access to healthy foods. The reasons for these behaviors are complex, and include many social, economic, environmental, and cultural factors.

Healthy Immigrant Families is a project aimed at improving physical activity and dietary habits among immigrants and refugees to Rochester, Minnesota. Healthy Immigrant Families used a CBPR approach to design an intervention aimed at improving physical activity and dietary habits with and for families from participating communities. The intervention included delivery of family-centered, home-based coaching for physical activity and healthy eating to participating Hispanic, Somali and Sudanese families. These lessons were facilitated by trained Family Health Promoters from the same community as the participants. Program efficacy was evaluated by measuring physical activity using accelerometers, and dietary quality by 24-hour dietary recalls. Other health indicators included measurement of blood pressure, body mass index (BMI), and health-related quality of life.

151 participants (44 families) were enrolled at baseline. At 12 months after enrollment, the intervention had been delivered to 100% of active families, and 93% of families were still engaged in study activities.

Funding

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

Materials

Intervention Manual

project deep-dive:risk communication

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