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.
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.
Publications
Diabetes Knowledge, attitudes and Behaviors Among Somali and Latino Immigrants
Experiences of Hispanic Safety Net Clinic Patients with Diabetes During the COVID-19 Pandemic
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
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
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.
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
Publications
Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population
Let’s Talk about TB
More than half of active tuberculosis (TB) cases in the United States occur in foreign-born individuals; the majority of these cases are attributable to reactivation of latent TB infection (LTBI). Reactivation of LBTI may be prevented with appropriate screening and treatment of those at risk.
More than half of active tuberculosis (TB) cases in the United States occur among foreign-born individuals, most of which result from reactivation of latent TB infection (LTBI), a condition that can be prevented through appropriate screening and treatment. Hawthorne Education Center (HEC) serves up to 2,500 adult learners each year, approximately 85% of whom are foreign-born, with nearly three-quarters originating from countries with a high TB burden. HEC experienced frequent cases of active TB among its learners, leading to health concerns and disruptions to school operations. Previous efforts to address TB through traditional approaches had been ineffective, prompting HEC staff to seek long-term solutions. In 2004, HEC partnered with researchers at Mayo Clinic to address the issue through a community-based participatory research (CBPR) approach.
Let’s Talk about TB is a TB prevention and control program at HEC and represented the first CBPR project for RHCP. The community–academic partnership included CBPR orientation, collaborative development of research strategies, and training workshops that built community capacity in focus group facilitation. Focus groups were conducted to explore learners’ perceptions of TB and identify barriers and facilitators to screening and treatment. Based on these findings, HEC staff, learners, and researchers co-developed culturally and linguistically appropriate educational tools, including posters, leaflets, and videos, to address common TB questions and concerns. Innovative educational interventions—such as classroom discussions, interactive learning activities, and demonstrations of TB testing—were implemented annually around World TB Day for three years. Learners were offered on-site TB testing, with those testing positive referred to the local health department for further evaluation and management. TB education and screening continue annually at HEC, supported by a streamlined referral process to the Olmsted County TB Clinic.
Publications
Current Concepts in the Management of Tuberculosis
Funding
National Institutes of Health: National Institute of Allergy and Infectious Diseases (R03 AI82703)
Mayo Clinic: Department of Medicine, and Center for Clinical and Translational Science
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.
Health literacy plays a critical role in shaping health behaviors and outcomes, yet nearly half of adults in the United States are estimated to have limited functional health literacy. Low health literacy disproportionately affects racial and ethnic minority populations, contributing to health disparities. Let’s Talk was a pilot project designed to test the feasibility and sustainability of a community-based health literacy curriculum focused on improving health knowledge and promoting healthy behaviors on topics identified directly by the community.
The project consisted of a series of educational sessions led by registered nurses who were graduate students in the Winona State University Nursing Program. These nurses worked with members of African American, Cambodian, Hispanic, Somali, and Sudanese communities to address health-care system navigation, disease prevention, health promotion, and chronic disease management. Nurses partnered closely with community leaders or liaisons to tailor the curriculum to each group’s needs, with sessions held in accessible, trusted settings such as schools, community centers, homes, apartment common rooms, and religious gathering places throughout Rochester. Session structure and frequency varied by community—for example, sessions were integrated into Cambodian Cultural School programming, held after church services for Sudanese and African American families, conducted with elderly Somali residents in their apartment buildings, and hosted in Hispanic families’ homes. Many sessions were based on Staying Healthy from the Florida Literacy Coalition, Inc., which was adapted to include Minnesota-specific health resources and expanded to address topics prioritized by Rochester community members.
Staying Healthy Guide
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.
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
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
Funding
Mayo Clinic: Center for Clinical and Translational Science and Department of Medicine