Current Concepts in the Management of Tuberculosis
Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acidfast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.
The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis
Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants
Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants.
A longitudinal qualitative analysis exploring Hispanic/Latino and Somali immigrant health promoters' perspectives on a social network intervention to address cardiovascular disease disparities
Evidence-based health promotion programs are commonly assessed within research environments, yet there is a critical need to understand how to implement interventions across multiple settings, prioritizing populations who are underserved and under-resourced. A possible approach involves leveraging established social networks to enhance health outcomes. Within these networks, influential individuals, known as health promoters (HPs), play a key role in disseminating health information. The Rochester Healthy Community Partnership created a social network–based intervention called Healthy Immigrant Community (HIC), utilizing HPs to encourage healthy eating and physical activity to address cardiovascular disease outcomes among Hispanic/Latino and Somali immigrant populations. We conducted three focus groups pre-, mid-, and post intervention (nine groups total; n = 30) to understand HPs’ motivations for participating, implementation barriers and facilitators they faced, and suggestions for improvement.
Background
Evidence-based health promotion programs are commonly assessed within research environments, yet there is a critical need to understand how to implement interventions across multiple settings, prioritizing populations who are underserved and under-resourced. A possible approach involves leveraging established social networks to enhance health outcomes. Within these networks, influential individuals, known as health promoters (HPs), play a key role in disseminating health information. The Rochester Healthy Community Partnership created a social network–based intervention called Healthy Immigrant Community (HIC), utilizing HPs to encourage healthy eating and physical activity to address cardiovascular disease outcomes among Hispanic/Latino and Somali immigrant populations. We conducted three focus groups pre-, mid-, and post intervention (nine groups total; n = 30) to understand HPs’ motivations for participating, implementation barriers and facilitators they faced, and suggestions for improvement.
Methods
Using the National Institute on Minority Health and Health Disparities Research Framework and Public Health Critical Race Praxis, we conducted a longitudinal trajectory analysis to explore themes and changes over time.
Results
Participants reported that their motivations to be a HP in Healthy Immigrant Community were personal goals, such as health improvement and weight loss, as well as collective community benefits and personal gains like knowledge and leadership skills. Barriers included logistical challenges, navigating health-related differences between one’s country of origin and the US, and structural issues such as racism, high costs (e.g., food), and absence of an affordable gym. Facilitators included strong community ties, peer-to-peer support, and culturally relevant approaches, with participants recommending additional resources, tailored programming, and reframing the program’s focus on overall health rather than weight loss.
Conclusions
Our study highlighted a shift in HPs’ motivations to participate in Healthy Immigrant Community from weight loss to holistic health promotion. The HPs’ reflections on their experience showcase the transformative impact of culturally tailored, equity-focused interventions while emphasizing the need to address systemic barriers and incorporate community feedback for sustainable change.
Body Size Perceptions Associated with Body Mass Index and Weight Loss Intentions Among Two Immigrant Populations
The rates of obesity among immigrant populations within the USA rise with increasing duration of residency. The aims of this study were to examine weight self-perception and body image discrepancy within a large community sample of Hispanic and Somali predominantly immigrant adults.
Background
The rates of obesity among immigrant populations within the USA rise with increasing duration of residency. The aims of this study were to examine weight self-perception and body image discrepancy within a large community sample of Hispanic and Somali predominantly immigrant adults.
Methods
Utilizing a community-based participatory research (CBPR) approach to collect survey data from a sample of adults who self-identified as Hispanic, Latino, or Somali in Southeast Minnesota. Correlations among actual body mass index (BMI), perceived weight category, and perceived body size were assessed with Spearman rank correlation coefficients. Associations of weight loss intentions with actual BMI, perceived weight category, perceived body size, and body image discrepancy were assessed using Kruskal–Wallis nonparametric tests.
Results
A total of 1256 adults completed the survey and biometric measurements (610 Hispanic, 646 Somali); 81% (457) and 50% (328) had a BMI in the overweight or obese category in the Hispanic and Somali cohorts, respectively. Among participants with a BMI of > 25, more participants reported a perceived body size that was overweight or obese than a perceived weight category that was in the overweight or obese category (79% vs. 48%, p = < 0.0001). Body image discrepancy, but not actual BMI, was associated with weight loss intentions for both groups. Perceived body size and perceived weight category were associated with weight loss intentions for Hispanic participants only.
Conclusions
Perceived body size is a more accurate self-report proxy of BMI-defined weight status compared with the perceived weight category among Hispanic and Somali immigrant groups. Body image discrepancy may be more predictive of weight loss intentions than actual BMI.
Digital Storytelling Interventions to Promote Cancer Screening Among Hispanic/Latino Adults in Primary Care Settings
Cancer is the leading cause of death among Hispanic/Latino individuals, yet many do not complete cancer screenings due to systemic barriers. To address this issue, Rochester Healthy Community Partnership (RHCP) created “Stories for Change: La detección temprana puede salvar vidas” (S4C-cancer prevention). This digital storytelling intervention involved eight Hispanic/Latino cancer survivors or co-survivors who shared their experiences by creating 2-min videos. Their heartfelt stories aim to help patients make informed decisions about cancer screenings. RHCP piloted S4C-cancer prevention at three clinical sites to assess intervention acceptability and success (cancer screenings completed).
Abstract
Cancer is the leading cause of death among Hispanic/Latino individuals, yet many do not complete cancer screenings due to systemic barriers. To address this issue, Rochester Healthy Community Partnership (RHCP) created “Stories for Change: La detección temprana puede salvar vidas” (S4C-cancer prevention). This digital storytelling intervention involved eight Hispanic/Latino cancer survivors or co-survivors who shared their experiences by creating 2-min videos. Their heartfelt stories aim to help patients make informed decisions about cancer screenings. RHCP piloted S4C-cancer prevention at three clinical sites to assess intervention acceptability and success (cancer screenings completed). A total of 51 participants who were overdue for cancer screenings were recruited (breast=13; cervical=12; colorectal women=14; colorectal men=12). After viewing the intervention, 100% intended to be screened in the future. Within 7 months, 45% of participants completed their recommended cancer screenings. Among those who were screened, 89% stated that their decision was “very much” influenced by S4C-cancer prevention. Participants who did not complete screening cited barriers such as time, lack of access to health education, and fear. Those who had previously screened for the targeted cancer were more likely to complete screening after viewing S4C-cancer prevention. Additionally, participants suggested enhancing the videos by including more education on various cancer topics. We found high acceptability of S4C-cancer prevention. Despite all participants intending to get screened, half completed screening within 7 months of viewing the intervention.
Evaluation of a Photovoice Exhibit About Immigrant Health Priorities in Southeast Minnesota
Rochester Healthy Community Partnership, a 20-year community based participatory research partnership, used photovoice to learn about Hispanic/Latino and Somali immigrants’ health concerns. Participants photographed their health-related priorities, reflected, developed policy recommendations, and shared photographs at a public event and rotating exhibit in 2024. More than 100 people attended the event (19 decision makers, 64 members of the public, 11 immigrant leader participants, 11 research staff). All decision-maker and public survey respondents reported learning something new about the priorities of Hispanic/Latino and Somali immigrants.
Abstract: Rochester Healthy Community Partnership, a 20-year community based participatory research partnership, used photovoice to learn about Hispanic/Latino and Somali immigrants’ health concerns. Participants photographed their health-related priorities, reflected, developed policy recommendations, and shared photographs at a public event and rotating exhibit in 2024. More than 100 people attended the event (19 decision makers, 64 members of the public, 11 immigrant leader participants, 11 research staff). All decision-maker and public survey respondents reported learning something new about the priorities of Hispanic/Latino and Somali immigrants.
Photovoice is a qualitative method often used in a community-based participatory research (CBPR) where participants take photographs to reflect upon and interpret a process of experience. Photovoice aims to help people document and reflect on their community, foster dialogue on key issues, and engage policy makers.
Exploring factors impacting Hispanic/Latinx individuals' response to a type 2 diabetes digital storytelling intervention
Hispanic/Latinx individuals have high prevalence of type 2 diabetes and its complications yet often face barriers in accessing diabetes prevention and self-managemenet interventions. One possible approach is to implement digital storytelling interventions, which involve narrative-driven videos made by individuals who have lived experience with particular conditions or illnesses. These stories can inspire viewers with similar life experiences to change behaviors or attitudes. Little is known about which characteristics influence how individuals respond to digital storytelling interventions with healthful behaviors and improved outcomes - information necessary to further tailor these interventions to improve type 2 diabetes outcomes. Previously, the Rochester Healthy Community Partnership used the digital storytelling process to develop Stories for Change Diabetes and tested intervention effectiveness.
Background: Hispanic/Latinx individuals have high prevalence of type 2 diabetes and its complications yet often face barriers in accessing diabetes prevention and self-managemenet interventions. One possible approach is to implement digital storytelling interventions, which involve narrative-driven videos made by individuals who have lived experience with particular conditions or illnesses. These stories can inspire viewers with similar life experiences to change behaviors or attitudes. Little is known about which characteristics influence how individuals respond to digital storytelling interventions with healthful behaviors and improved outcomes - information necessary to further tailor these interventions to improve type 2 diabetes outcomes. Previously, the Rochester Healthy Community Partnership used the digital storytelling process to develop Stories for Change Diabetes and tested intervention effectiveness.
Methods: We conducted a secondary analysis to examine the sociodemographic and disease-related factors that affected participants’ responses to the Stories for Change Diabetes intervention. Drawing on Social Cognitive Theory and Culture-Centric Health Promotion principles, we analyzed results from the 227 intervention participants stratified by whether they experienced a clinically meaningful decrease (>0.5%) in hemoglobin A1c between baseline and three-month follow-up. We used multivariable logistic regressions to identify factors associated with change in hemoglobin A1c.
Results: Participants with diabetes duration <5 years and/or whose diabetes self-efficacy improved between baseline and 3-month follow-up were more likely to experience a meaningful decrease in hemoglobin A1c at three months (compared to participants without those characteristics).
Conclusion: These findings will provide insight into how digital storytelling interventions can be effectively tailored to a Hispanic/Latinx individuals most likely to benefit.
Digital Storytelling Intervention for Hemoglobin A1c Control Among Hispanic Adults With Type 2 Diabetes A Randomized Clinical Trial
Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking.
Background: Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking.
Methods: To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D, we conducted a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials. The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires.
Results: There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high.
Conclusion: In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults.
Negative Mood is Associated with Sociobehavioral Factors Contributing to Cardiovascular Risk in an Immigrant Population
After settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US population, mood may be an important mediating factor in immigrant populations.
Background: After settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US population, mood may be an important mediating factor in immigrant populations.
Methods: The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention designed to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered “negative”, while ratings of good, very good, or excellent were considered “positive”.
Results: Hispanic/Latino (n = 268) and Somali (n = 181) adults enrolled in HIC completed baseline measures and were included in this analysis. Participants endorsing negative mood compared to positive mood had lower healthy eating scores (p = 0.02), lower physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood reported receiving less social support to eat healthy (p = < 0.001) and be physically active (p = 0.01). They also accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) less frequently than participants endorsing positive mood.
Conclusions: On self-report, negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions to reduce obesity and cardiovascular risk among immigrants who report negative mood.
Healthy immigrant community study protocol: A randomized controlled trial of a social network intervention for cardiovascular risk reduction among Hispanic and Somali adults
Evidence-based health promotion programs in group settings have been shown to be effective at improving health behaviors in general populations, [7] but despite calls for interventions to address obesity and health behaviors among immigrant populations, [8] few intervention studies have been reported. [9]
Immigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations.
We developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's “Life's Simple 7”: BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality.
A total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5–12). The mean BMI of the sample (32.2) was in the “obese” range.
Processes and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.
Development of a Digital Storytelling Intervention to Increase Breast, Cervical, and Colorectal Cancer Screening in the Hispanic/Latino Community: a Qualitative Evaluation
Culturally tailored interventions are needed to address cancer screening disparities [6, 7]. One potential solution is using digital storytelling (DST) [8].
Digital storytelling (DST) interventions may be one way to address disparities in cancer screening experienced by the Hispanic/Latino population. Digital stories are short, first-person narratives that include voice-over narration and images. With storytellers’ permission, researchers can screen digital stories as a health intervention. Digital stories can inspire viewers to adopt or change their behavior, such as completing cancer screening.
Rochester Healthy Community Partnership (a 20-year community-based participatory research partnership) together with eight Hispanic/Latino, Spanish speaking cancer survivors, co-survivors, or recently screened individuals, developed digital stories about breast, cervical, and colorectal cancer screening. Here, we describe our qualitative evaluation of the DST workshop. To understand what the storytellers thought viewers would find relatable in their digital stories, we applied Narrative Theory. We also assessed workshop successes and opportunities for improvement. We used the constant comparative method for data analysis.
We learned that the storytellers anticipated their stories would be engaging and that viewers would connect with Hispanic/Latino cultural values. During the workshop, the storytellers felt like they were making an important contribution. The storytellers highlighted specific opportunities for improvement including sharing the stories more quickly after the workshop. Future research is needed to test whether this intervention follows the Narrative Theory causal pathway by persuading viewers to complete recommended cancer screenings.
Addressing COVID-19 inequities using bidirectional crisis and emergency risk communication and vaccine clinic interventions: a descriptive study
Im/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities.
Im/migrants (immigrants and migrants, including refugees, asylum seekers, and individuals without legal documentation) experience unique assets and needs in relation to coronavirus disease 2019 (COVID-19). Community-based participatory research (CBPR) is one way to engage im/migrant communities.
Rochester Healthy Community Partnership (RHCP) is a CBPR partnership in Rochester, Minnesota. RHCP partners noted that credible COVID-19 information was not available to their communities. In response, RHCP formed a COVID-19 Task Force and adapted the Centers for Disease Control and Prevention’s Crisis and Emergency Risk Communication (CERC) framework to create an intervention that prioritized im/migrant groups experiencing health disparities.
In the CERC intervention, communication leaders delivered COVID-19 health messages to their social networks and documented related concerns. RHCP relayed these concerns to regional leaders to ensure that im/migrant experiences were included in decision making. Once vaccines were available, RHCP continued to deploy the CERC intervention to promote vaccination equity.
The aims of this paper are to (1) describe the implementation of a bidirectional CERC intervention for vaccination equity, and (2) describe a community-engaged and community-based vaccine clinic intervention.
Adaptation of a bidirectional crisis and emergency risk communication framework by community-engaged research partnerships in rural Mississippi during the COVID-19 pandemic
Community engagement is important for reaching populations at risk for health inequities in the coronavirus disease 2019 (COVID-19) pandemic.
Community engagement is important for reaching populations at risk for health inequities in the coronavirus disease 2019 (COVID-19) pandemic. A community-engaged risk communication intervention implemented by a community-engaged research partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts has demonstrated high acceptability, feasibility, perceived efficacy, and sustainability.
In this study, we describe the adaptation of the intervention by a community-academic partnership with rural African American populations in three Mississippi counties with high COVID-19 disparities. Intervention reach was assessed by the number of messages delivered by Communication Leaders to members of their social networks. Perceived scalability of the intervention was assessed by the Intervention Scalability Assessment Tool. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, meet resource needs, and advise statewide decision-makers.
In the first 3 months, more than 8482 individuals were reached in the three counties. The intervention was deemed to be highly scalable by partnership members. Adaptation of a community-engaged pandemic CERC intervention is feasible and scalable, and it has the potential to reduce COVID-19 inequities across heterogeneous populations. This approach may be incorporated into current and future pandemic preparedness policies for community engagement.
Rochester Healthy Community Partnership: Then and now
Community-engaged research partnerships promote health equity through incorporation of regional contexts to inform partnership dynamics that shape research and interventions that reflect community voice and priorities.
Community-engaged research partnerships promote health equity through incorporation of regional contexts to inform partnership dynamics that shape research and interventions that reflect community voice and priorities. Long-term partnerships build trusted relationships and promote capacity building among community and academic partners, but there are many structural barriers to sustaining long-term partnerships.
Here we describe lessons learned from sustaining Rochester Healthy Community Partnership (RHCP), an 18-year community-based participatory research (CBPR) partnership in Southeast Minnesota. RHCP collaborates with immigrant and refugee populations to co-create interventions that promote health equity for community health priorities. Challenges to sustainability include a tension between project-based funding and the needs of long-term community-based research infrastructure. These challenges can be met with a focus on shared CBPR principles, operating norms, partnership dynamics, and governance.
RHCP began in 2004 through identification of a community health priority, defining the community, and establishment of CBPR principles. It grew through identification of broader community health priorities, capacity building for community and academic partners, and integration of diverse learners. We describe the capacity for RHCP to respond to new societal contexts, the importance of partnership dynamics as a barometer for partnership health, and lessons learned about sustainability of the CBPR partnership.
Stories for Change Protocol: A Randomized Controlled Trial of a Digital Storytelling Workshop Intervention for Hispanic/Latino with Type 2 Diabetes
Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D).
Contemporary Clinical Trials 126 (2023) 107093
Abstract
Background: Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics.
Methods: Study eligibility criteria: Hispanic or Latino, age 18–70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data.
Results: Participants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories.
Conclusion: We present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations.
The Use of Digital Stories As a Health Promotion Intervention: A Scoping Review
It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS).
BMC Public Health (2022) 22:1180
Abstract
Background: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for refection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants’ permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps.
Methods: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article.
Results: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our map‑ ping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment).
Conclusions: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.
Keywords: Digital storytelling, Storytelling, Health promotion, Health disparities, Health equity, Scoping review
The Recruitment to Dissemination Continuum in Community-based Participatory Research
The dissemination of research findings is a critical component of late translation research, but dissemination remains focused on academic audiences despite multiple studies demonstrating that research participants desire to know the key findings of studies in which they were involved.
Progress in Community Health Partnerships: Research, Education, and Action, Vol. 6.2
Abstract
Background: Dissemination of research findings to participants and communities, particularly among traditionally marginalized groups, is a systemic challenge. In community based participatory research (CBPR), long-term partnerships may foster a link between recruitment to research studies, dissemination of results, and recruitment to future studies.
Objectives: To analyze the recruitment to dissemination continuum of a CBPR study and its potential impact on partnership processes and future research.
Methods: We conducted a qualitative study with four focus groups with community members and academic partners who participated in the recruitment and the dissemination of research findings from a study of Hispanic and Somali social networks in Rochester, Minnesota. Thematic analysis and coding of focus group transcripts was conducted by investigators. The CBPR conceptual model for this partnership
guided the analysis.
Results: Trust, relationship building, and capacity building were key features for successful participant recruitment and research dissemination strategies. Strategies, resources, and relationships used or developed during the recruitment phase of research were directly applied to planning a dissemination event. Participants and members of their communities said they were more likely to participate in future research studies as a result of attending a dissemination event.
Conclusions: This study demonstrated the ways in which recruitment of marginalized populations to research studies and dissemination of study results can manifest as a continuum. This continuum is nurtured by trust, longitudinal relationships, and robust partnership dynamics. These factors fit well within an existing CBPR conceptual model.
Experiences of Hispanic Safety Net Clinic Patients With Diabetes During the COVID-19 Pandemic
The inequitable impact of the COVID-19 pandemic in the United States resulted in substantial loss of life in Hispanic communities. Life expectancy among US Hispanics declined 3 years, the most of any race/ethnicity subgroup, from 2019 to 2020. Although COVID-19 led to a majority of this decline (90%), diabetes was noted as the third leading cause of increased deaths, behind unintentional injuries.
Abstract
Purpose: The purpose of this study was to characterize the material, health (general and diabetes-specific), and social impacts of the COVID-19 pandemic on Hispanic adults with type 2 diabetes who did not experience COVID-19 infection.
Methods: This cross-sectional and longitudinal study used surveys within a clinical trial of 79 Hispanic adult clinic patients with type 2 diabetes. Cross-sectional measures included the Coronavirus Anxiety Scale, items from the Coronavirus Impact Scale, and the Pandemic Impacts Inventory. Longitudinal measures included the Summary of Diabetes Self-Care, health care utilization, and measures of diabetes self-efficacy, social support, and quality of life.
Results: Participants were majority low-income, Spanish-speaking females with poor diabetes control. Coronavirus anxiety was low despite majority of participants having an affected family member and frequent access barriers. More than half of participants reported moderate/severe pandemic impact on their income. Diabetes self-care behaviors did not change between prepandemic and pandemic measures. Diabetes self-efficacy and quality of life improved despite fewer diabetes-related health care visits.
Conclusions: Despite high levels of access barriers, financial strain, and COVID-19 infection of family members, Hispanic adults with type 2 diabetes continued to prioritize their diabetes self-management and demonstrated substantial resilience by improving their self-efficacy and quality of life.
Keywords: type 2 diabetes, immigrant and refugee health, social determinants of health, COVID-19
Pilot Social Network Weight Loss Intervention With Two Immigrant Populations During the COVID-19 Pandemic
Immigrants often arrive to the United States (US) at a healthier weight compared to the general US population, but these healthy weight advantages disappear over time, and the rates of obesity, with associated complications, rise.
American Journal of Health Promotion 2022, Vol. 0(0) 1–14 © The Author(s) 2022
Abstract
Purpose: To examine the feasibility and acceptability of a social network weight loss intervention delivered by lay health promoters (HPs) to immigrant populations.
Design: Single-arm, non-randomized, pilot study of a social network weight loss intervention developed by a community-based participatory research partnership and delivered by HPs. Setting: Community-based setting in Southeastern Minnesota, United States.
Sample: Somali and Hispanic immigrants to the United States: 4 social networks of adults (2 Hispanic and 2 Somali) with 39 network participants.
Intervention: Twelve-week behavioral weight loss intervention delivered by HPs (4 weeks in-person and then 8 weeks virtual).
Measures: Feasibility was assessed by recruitment and retention rates. Acceptability was assessed by surveys and focus groups with HPs and participants. Behavioral measures included servings of fruits and vegetables, drinking soda, and physical activity. Physiologic measures included weight, blood pressure, glucose, cholesterol, and triglycerides.
Analysis: Paired t-tests of pre- to post-intervention changes at the end of 12 weeks of treatment.
Results: Recruitment was feasible and post-intervention was 100%. Participants highly rated the intervention on satisfaction, motivation, and confidence to eat a healthy diet, be physically active, and lose weight. Participants were motivated by group social support and cohesion of their social networks. On average, participants lost weight (91.6 ± 15.9 to 89.7 ± 16.6 kg, P <.0001), lowered their systolic blood pressure (133.9±16.9 to 127.2 ± 15.8 mm Hg; P < .001), lowered their diastolic blood pressure (81 ± 9.5 to 75.8 ± 9.6 mm Hg; P < .0001), had more servings of vegetables per day (1.9 ± 1.2 to 2.6 ± 1.4; P < .001), and increased their physical activity (2690 ± 3231 to 6595 ± 7322 MET-minutes per week; P = .02).
Conclusion: This pilot study of 2 immigrant communities who participated in a peer-led weight loss social network intervention delivered during the COVID-19 pandemic demonstrated high feasibility and acceptability. Participants lost weight, improved their health status, and improved their health behaviors.
Community-Engaged Bidirectional Crisis and Emergency Risk Communication With Immigrant and Refugee Populations During the COVID-19 Pandemic
Crisis and emergency risk communication (CERC) frameworks encourage public participation in pandemic prevention and containment, but effective implementation depends, in part, on reaching populations with a history of health disparities and limited access to culturally and linguistically tailored health information.
SAGE Publishing and Public Health Reports. 2022
Abstract
Objectives: This study was conducted to assess an intervention that was created by a community–academic partnership to address COVID-19 health inequities. We evaluated a community-engaged bidirectional pandemic crisis and emergency risk communication (CERC) framework with immigrant and refugee populations during the COVID-19 pandemic.
Methods: A 17-year community-engaged research partnership adopted a CERC framework in March 2020 to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant and refugee groups in southeast Minnesota. The partnership used bidirectional communication between communication leaders and their social networks to refine messages, leverage resources, and advise policy makers. We conducted a mixed-methods evaluation for intervention acceptability, feasibility, reach, adaptation, and sustainability through multisource data, including email communications, work group notes, semistructured interviews, and focus groups.
Results: The intervention reached at least 39 000 people in 9 months. It was implemented as intended and perceived efficacy was high. Frequent communication between community and academic partners allowed the team to respond rapidly to concerns and facilitated connection of community members to resources. Framework implementation also led to systems and policy changes to meet the needs of immigrant and refugee populations.
Conclusions: Community-engaged CERC is feasible and sustainable and can reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies.