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

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 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

Nate Nordstrom 7/26/17 Nate Nordstrom 7/26/17

Club Fit

Club Fit was an initiative aimed at promoting healthy habits and preventing excess weight gain among children members at the Boys and Girls Club of Rochester, Minnesota (BGCR). Obesity is associated with increased risk for cardiovascular, metabolic, and other health conditions and for psychosocial concerns such as bullying, stigma, and emotional difficulties. Approximately one-third of children and adolescents in the U.S. are obese or overweight. Childhood obesity disproportionately affects children of ethnic minorities and low-income populations. BGCR serves over 1,600 children each year. Close to two-thirds are from racial/ethnic minority groups, and a majority live in low-income homes. BGCR offers youth development programs and services in several core areas including Health and Life Skills, which focus on physical activity and nutrition.

The initial formative phase of Club Fit was to review existing physical activity and nutrition programming, and to define opportunities to enhance these programs at BGCR. During this phase, researchers conducted focus groups, surveys, and physical measures to assess perceived barriers, facilitators, and opportunities for improvement to sustaining healthful physical activity and nutrition behaviors among BGCR members.

BGCR leaders and staff worked with health promotion experts from Mayo Clinic and RHCP to develop a physical activity and nutrition intervention administered as part of regular programming at BGCR.

In the second phase, BGCR staff administered the intervention, while researchers conducted pre-post assessments among Club members, to evaluate the effectiveness of the intervention. Assessments demonstrated an improvement in members’ motivation and self-efficacy for engaging in regular physical activity. The evaluation also showed a dose-response relationship between participation in Club Fit activities and healthier body mass index. Following the formal evaluation, BGCR continued to utilize the Club Fit intervention elements as part of its Health and Life Skills curriculum.

Funding

Mayo Clinic: Center for Clinical and Translational Science and Office of Health Disparities Research

Nate Nordstrom 7/25/17 Nate Nordstrom 7/25/17

Positive Loser

Immigrants and refugees to the United States have physical activity levels and dietary behaviors that are less healthy than the non-immigrant majority. Low levels of physical activity and poor dietary behaviors are associated with greater risks for obesity, diabetes and cardiovascular diseases. Interventions aimed at increasing physical activity and improving dietary quality among immigrants and refugees may promote healthier lifestyles and prevent chronic diseases.

Positive Loser was a pilot fitness program for exercise and nutrition for women with little experience with exercise, aimed at improving confidence in being physically active and eating a healthy diet. Positive loser was a six-week program with classes that met two times a week at the Rochester Area Family YMCA. Each class had two parts: 60 minutes of physical activity and 30 minutes of nutrition education. This socio-culturally appropriate wellness program for women was co-created by community leaders and researchers based on feedback obtained during a half-day fitness retreat, along with data from focus groups. About 50 Somali, Cambodian, Hispanic, and African American women in Rochester participated in the program. Pre and post measurements showed that participants had lower weight, lower blood pressure, lower waist-hip ratios, and reported improved self-confidence about exercise and diet, along with improved quality of life. The experience and results from this project led to the Healthy Immigrant Families project.

Funding

Mayo Clinic: Center for Clinical and Translational Science and Department of Medicine

Through The Lens: Immigrant Perspectives on Health in Southeast Minnesota

Social Network Analysis

Healthy Immigrant Community

Healthy Immigrant Families

Club Fit

Positive Loser

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