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

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 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.

Although immigrants and refugees often arrive in the United States with better health than the general population, these advantages diminish over time, in part due to the adoption of unhealthy dietary behaviors. Population-based interventions have had limited success in preserving these early health advantages, highlighting the need for innovative approaches that are tailored to—and led by—immigrant communities themselves. In 2011, RHCP received funding for the Healthy Immigrant Families (HIF) project, in which community and academic partners co-developed a 12-lesson, home-based intervention focused on healthy eating and physical activity, delivered by bilingual interventionists. At 12 months, adults in the intervention group showed significant improvements in dietary quality compared with controls, although improvements were also observed in the control group.

These findings led to the development of the Healthy Immigrant Community (HIC) project, which builds on the HIF model by leveraging social networks to enhance reach, sustainability, and behavior change. The goal of HIC is to adapt the HIF intervention into a social network–based approach to improve dietary behaviors among overweight and obese immigrant adults in Rochester, Minnesota. In February 2020, RHCP launched a pilot study in which Hispanic and Somali adults were trained as Health Promoters through 12 face-to-face lessons taught by Mayo Clinic experts, after which the Health Promoters delivered the same content to social networks of five to ten individuals. Building on this pilot, RHCP enrolled 475 participants in a randomized clinical trial in June 2022, with Health Promoters receiving ongoing training from Health Coaches and leading face-to-face or virtual group sessions over 12 months, each focused on key aspects of healthy eating and physical activity. Preliminary results from the HIC trial indicate that participants have reduced cardiovascular risk and experienced weight loss. These early findings are currently being disseminated to the community through RHCP’s established outreach and engagement channels.

Publications

Healthy Immigrant Community Study Protocol: A Randomized Controlled Trial of a social Network Intervention for Cardiovascular Risk Reduction Among Hispanic and Somali Adults

Pilot Social Network Weight Loss Intervention with Two Immigrant Populations During the COVID-19 Pandemic

Negative Mood is Associated with Sociobehavorial Factors Contributing to Cardiovascular Risk in an Immigrant Population

A Longitudinal Qualitative Analysis Exploring Hispanic/Latino and Somali Immigrant Health Promoters’ Perspectives on a Social Network Intervention to Address Cardiovascular Disease Disparities

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.

Immigrants and refugees often arrive in the United States with better overall health than the general population; however, over time, their cardiovascular risk profiles increasingly resemble those of U.S.-born populations. This shift includes higher rates of obesity, hypertension, high cholesterol, diabetes, and heart disease, driven in part by low levels of physical activity and limited access to healthy foods. These behaviors are shaped by a complex interplay of social, economic, environmental, and cultural factors that influence lifestyle choices and health opportunities.

Healthy Immigrant Families was a community-based participatory research (CBPR) project designed to improve physical activity and dietary habits among immigrant and refugee families in Rochester, Minnesota. The intervention was developed with and for participating communities and delivered through family-centered, home-based coaching focused on physical activity and healthy eating. Coaching was provided by trained Family Health Promoters from the same communities as participants and engaged Hispanic, Somali, and Sudanese families. Program effectiveness was evaluated using objective and self-reported measures, including accelerometer-based physical activity, 24-hour dietary recalls, blood pressure, body mass index (BMI), and health-related quality of life. A total of 151 participants from 44 families were enrolled at baseline, and at 12 months, the intervention had reached 100% of active families, with 93% remaining 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

Publications

Healthy Immigrant Families: Randomized Controlled Trial of a Family-Based Nutrition and Physical Activity Intervention

Health Immigrant Families: Participatory Development and Baseline Characteristics of a Community-Based Physical Activity and Nutrition Intervention

A Focus Group Study of Healthy Eating Knowledge, Practices, and Barriers Among Adult and Adolescent Immigrants and Refugees in the United States

Lessons Learned from Community-Led Recruitment of Immigrants and Refugee Participants for a Randomized, Community-Based Participatory Research Study

Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population

Treatment Fidelity Among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families

Lay Health Worker as Interventionist Training: Reflective Writing in US Family Health Promotion Practice

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.

Club Fit was an initiative designed to promote healthy habits and prevent excess weight gain among children at the Boys and Girls Club of Rochester, Minnesota (BGCR). Childhood obesity is linked to increased risk for cardiovascular and metabolic conditions, as well as psychosocial concerns such as bullying, stigma, and emotional difficulties. In the United States, approximately one-third of children and adolescents are overweight or obese, with disproportionate impacts on children from racial/ethnic minority groups and low-income households. BGCR serves more than 1,600 children annually, nearly two-thirds of whom identify as racial or ethnic minorities, and the majority of whom live in low-income homes. Through its youth development programming, BGCR emphasizes Health and Life Skills, including physical activity and nutrition, as a core area of focus.

The formative phase of Club Fit involved reviewing existing physical activity and nutrition programming and identifying opportunities for enhancement. Researchers conducted focus groups, surveys, and physical assessments to examine barriers, facilitators, and opportunities for sustaining healthy behaviors among BGCR members. Using these findings, BGCR leaders and staff partnered with health promotion experts from Mayo Clinic and RHCP to develop a physical activity and nutrition intervention integrated into regular BGCR programming. In the second phase, BGCR staff delivered the intervention while researchers conducted pre- and post-assessments to evaluate its effectiveness. Results showed improvements in participants’ motivation and self-efficacy for engaging in physical activity, as well as a dose-response relationship between participation in Club Fit activities and healthier body mass index. Following the evaluation, BGCR continued incorporating Club Fit components into its Health and Life Skills curriculum.

Funding

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

Publications

Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site

Healthy Eating in a Boys and Girls club Afterschool Programme: Barriers, Facilitators and Opportunities

Club Fit: Development of a Physical Activity and Healthy Eating Intervention at a Boys & Girls Club After School Program

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.

Immigrants and refugees in the United States often experience lower levels of physical activity and poorer dietary behaviors compared with the non-immigrant population, placing them at increased risk for obesity, diabetes, and cardiovascular disease. Interventions that promote physical activity and healthy eating may help reduce these disparities and prevent chronic disease. Positive Loser weas a pilot exercise and nutrition program designed for women with limited experience in physical activity, with the goal of increasing confidence in being physically active and adopting healthier dietary habits. The six-week program met twice weekly at the Rochester Area Family YMCA and consisted of 60 minutes of physical activity followed by 30 minutes of nutrition education. The program was a socio-culturally tailored wellness intervention co-created by community leaders and researchers, informed by feedback from a half-day fitness retreat and focus group data. Approximately 50 Somali, Cambodian, Hispanic and African American women in Rochester participated. Pre and post program assessments showed reduction in weight, blood pressure, and waist-to-hip ratios, as well as improvements in self-confidence related to exercise, exercise and overall quality of life. The success and lessons learned from Positive Loser informed the development of the Healthy Immigrant Families (include link to HIF project page) project.

Publications

Physical Activity and Nutrition Among Immigrant and Refugee Women: A Community-Based Participatory Research Approach

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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