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

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. 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)

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

Let’s Talk

Healthy literacy influences health behaviors and health outcomes. It is estimated that close to half of the adult United States population is functionally illiterate when it comes to health. Adults with low literacy levels are disproportionately racial and ethnic minorities. Let’s Talk was a pilot project to test the feasibility and sustainability of a community-based health literacy curriculum aimed at improving knowledge and healthy behaviors on topics identified by the community.

The project consisted of a series of information sessions where students of Winona State University Graduate Programs in Nursing, who are registered nurses, discuss health-care system navigation, health prevention, health promotion, and chronic disease management with members of African American, Cambodian, Hispanic, Somali and Sudanese communities who participated in the program. Nurses worked closely with community leaders or liaisons on refining the program to meet community needs. These information and learning sessions took place in various locations around Rochester, such as schools, community centers, homes, and religious gathering places. Sessions varied for different community groups, based on the recommendations of the respective community leaders or liaisons. For example, sessions were incorporated once a week during Cambodian Cultural School, and after church services with Sudanese families and those belonging to the African American community. Nurses met with elderly Somalis at the common room of their apartment building, and with Hispanic families at home. In many instances, the sessions followed the curriculum contained in a book called Staying Healthy from the Florida Literacy Coalition, Inc., which was adapted to provide Minnesota specific health resource information, and expanded to focus on topics of interest identified by Rochester communities.  Click for PDF.

Funding

Winona State University Foundation
Mayo Clinic: Center for Clinical and Translational Science

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