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.
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.
Healthy Eating in a Boys and Girls Club Afterschool Programme: Barriers, Facilitators, and Opportunities
Obesity and poor dietary habits are a significant health problem for children from economically and socially disadvantaged backgrounds. In the USA, children from minority and low-income backgrounds face substantially greater environmental challenges to engage in healthy eating and other health behaviors to maintain a healthy weight.
Health Education Journal. 10 July 2020, Vol. 79(8) 914-931
Background: To determine intervention needs and to gather stakeholder input regarding healthy eating promotion for youth members served at a Boys & Girls Club in Rochester, Minnesota.
Methods: Young people completed a dietary habits questionnaire and height and weight measure-ments. Focus groups gathered stakeholder – Boys & Girls Club members, staff, caregivers – perspectives on opportunities to improve children’s healthy eating through the club setting. Content analysis identified major themes in informants’ accounts.
Results: Participants identified individual and environmental barriers to healthy eating and opportunities to reduce barriers at this Boys & Girls Club site. Few children met basic nutritional guidelines related to fruit, vegetable, milk and water consumption, and limiting consumption of sugar-sweetened beverages, and nearly half were overweight/obese. Stakeholders expressed interest in healthy eating promotion and identified multiple individual-level, interpersonal and environmental opportunities to promote healthier eating through the Boys & Girls Club site.
Conclusion: Findings build on a growing literature indicating afterschool programmes are uniquely positioned to address health disparities related to pediatric nutrition and obesity, and can be used to inform the design of a multi-layered intervention to address the complexities influencing dietary quality and obesity among diverse and underserved youth.
Club Fit: Development of a Physical Activity and Healthy Eating Intervention at a Boys & Girls Club After School Program
The childhood obesity epidemic includes well documented health and psychosocial comorbidities that affect 17% of children in the United States. Previous research has demonstrated that children and adolescents from minority and low income backgrounds face substantially greater social and environmental challenges to engage in physical activity and healthy eating to maintain a healthy weight.
Journal of Primary Prevention. 2020 Apr;41(2):153-170
Background: The childhood obesity epidemic includes well documented health and psychosocial comorbidities that affect 17% of children in the United States (Ogden, Carroll, Kit, & Flegal, 2012). Previous research has demonstrated that children and adolescents from minority and low income backgrounds face substantially greater social and environmental challenges to engage in physical activity and healthy eating to maintain a healthy weight (Miech et al., 2006). Low levels of physical activity, high levels of sedentary behavior and poor dietary quality are the primary drivers of childhood obesity, and these behaviors are more prevalent among youth from low income and underserved families.
Methods: The study was part of Club Fit, a collaboration of Boys & Girls Club of Rochester, MN, (BGCR) and the Rochester Healthy Community Partnership (RHCP). BGCR is a community organization that offers after-school programs for youth. Its health promotion programs are designed to demonstrate and promote healthy eating and physical activity among youth. BGCR is particularly well-positioned to address health disparities in the community related to nutrition, physical activity, and risk for childhood obesity, as it serves a diverse population of children with large representation of youth from low-income backgrounds; 73% of BGCR members receive free or reduced meals at school, and 41% live in single-parent homes. The mission of RHCP is ‘to promote health and wellbeing among the Rochester community through CBPR, education, and civic engagement to achieve health for all’ (www.roche sterh ealth y.org). RHCP has 12 years of experience implementing and evaluating theorydriven community-based interventions, including work aimed at obesity prevention (Wieland et al., 2016).
Results: The mean age of participants was 10.4 years, and the majority of participants were female (69%), not White (66%), and overweight or obese (52%). Of the 61 participants, only 9 were older than 12 years, and their attendance at Club Fit Huddles was considerably lower than for participants ages 8–12 (mean 5.3 ± 1.8 vs. 9 ± 5.2; p = 0.08). There were statistically significant improvements in self-efficacy and motivation for physical activity from baseline to 6 months and nonsignificant improvements for fruit and vegetable consumption, sugary beverage consumption, and screen time. There were no improvements in social support, physical activity, dietary quality, or BMI z score. Results of univariate analyses did not find significant differences by age, ethnicity, or sex. The mean (SD) attendance at Club Fit Huddles was 8.1 (4.9) sessions out of 32 total Huddles. The mean attendance at Club Fit Huddles and Fitness Challenge was 12.8 (7.5) sessions out of 46 total opportunities. There was a statistically significant correlation between increased Huddle attendance and decreased BMI z score.
Conclusion: Club Fit is a childhood obesity prevention initiative that promotes physical activity and healthy eating at a Boys & Girls Club after-school program. Results of this pilot study indicated that while there were no differences in nutrition outcomes, the intervention was associated with improved self-efficacy and motivational level for physical activity and that increased attendance in Club Fit programming was correlated with decreased BMI z scores. According to these promising preliminary data and the revisions to the intervention components that were informed by the pilot, this intervention warrants testing through a controlled experiment with other after-school programs. Processes and products from this study may be helpful to other communities aiming to address childhood obesity prevention through after-school programs.
Association of Social Network Factors With Weight Status and Weight Loss Intentions Among Hispanic Adults
In the midst of a well-documented obesity epidemic in the United States, Hispanic adults are 1.2 times more likely to be obese than non-Hispanic whites, representing the highest age-adjusted obesity prevalence in the country.
Journal of Behavioral Medicine. 2020 Apr;43(2):155-165
Abstract: Hispanic adults have the highest obesity prevalence in the United States, but little is known about weight-related social network influences. A community-based sample of 610 Hispanic participants completed height/weight and a survey. The proportion of overweight or obese (OW/OB) network members was higher for OW/OB respondents compared to normal weight respondents. Participants with high weight loss intentions reported more positive social norms for weight control, social support, and social cohesion. If most or all of OW/OB participant's social contacts were trying to lose weight, the odds that they were likely to try to lose weight was four times higher than other participants. The relationship between weight loss intentions and number of social contacts trying to lose weight was strongly mediated by social norms for weight control and social support. These results suggest that social contacts and functional network characteristics may impact weight status and weight control intentions among Hispanic adults.
Social Networks and Obesity Among Somali Immigrants and Refugees
Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic.
BMC Public Health. 2020 Feb 17;20(1):238
Background: Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates.
Methods: Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention.
Results: Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms.
Conclusion: In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.
Identifying Opportunities to Promote Physical Activity in a Diverse Low-Income Population: A Mixed-Method Study at a Boys & Girls Club Site
Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (USA) that disproportionally affect children from low income and minority families.
Journal of Research and Practice in Children's Services: Child & Youth Care Forum volume 49, pages171–200(2020)
Background: Prevalence and consequences of obesity and sedentary lifestyle are well-documented public health concerns for youth in the United State of America (USA) that disproportionally affect children from low income and minority families.
Methods: Social cognitive learning theory, the ecological model of health behavior, and community based participatory research principles provided the study framework. Members completed assessments of physical activity, sedentary activity, height, and weight. Focus groups with members, staff, and parents/caregivers identified barriers, facilitators, and opportunities for promoting physical activity.
Results: Nearly 50% of members were overweight or obese. Most (87%) participants reported at least 60 min physical activity every day across the 3-day recall. Fewer than half (41%) reported 2 h or less of sedentary screen time every day across the 3 day recall. Focus group themes identified opportunities for addressing needs associated with health disparities in physical activity and pediatric obesity.
Conclusion: Findings suggest stakeholder interest in physical activity promotion through afterschool programs. We discuss study implications regarding needs specific to individuals from diverse, low-income households that may not be adequately addressed with existing empirically-supported treatments and opportunities to address health disparities in physical activity and pediatric obesity through afterschool programs.
Healthy Immigrant Families: Randomized Controlled Trial of a Family-Based Nutrition and Physical Activity Intervention
Populations that immigrate to high-income nations generally have less healthy behaviors than the nonimmigrant majority populations.
American Journal of Health Promotion 2018, Vol. 32(2) 473-484
Background: The purpose of this study was to evaluate a healthy eating and physical activity intervention for immigrant families, derived through community-based participatory research.
Methods: Participants were recruited by community partners from Hispanic, Somali, and Sudanese immigrant communities. Family health promoters from participating communities delivered six healthy eating modules, four physical activity modules, and two modules synthesizing information in 12 home visits (60-90 minutes) within the first six months. Up to 12 follow-up phone calls to each participant occurred within the second six months. Primary measures were dietary quality measured with weekday 24-hour recall and reported as Healthy Eating Index score (0-100) and physical activity measured with accelerometers (14 wear days) at baseline, 6, 12, and 24 months.
Results: In total, 151 persons (81 adolescents and 70 adults; 44 families) were randomly assigned. At 12 months, significant improvement occurred in Healthy Eating Index scores for adults in the intervention group compared with controls (change, +8.6 vs -4.4; P < .01) and persisted at 24 months (+7.4 from baseline; P < .01). No differences were observed for adolescents and no significant differences occurred between groups for physical activity.
Conclusion: This intervention produced sustained dietary quality improvement among adults but not among adolescents. Program outcomes are relevant to communities working to decrease cardiovascular risk among immigrant populations.
Relationship Between Negative Mood and Health Behaviors in an Immigrant and Refugee Population
Immigrants experience an escalation of negative health behaviors after arrival to the United States.
Journal of Immigrant and Minority Health (2017) 19(3): 655-664.
Background: Immigrants experience an escalation of negative health behaviors after arrival to the United States. Negative mood is associated with poorer health behaviors in the general population; however, this relationship is understudied in immigrant populations.
Methods: Adolescent (n = 81) and adult (n = 70) participants completed a health behavior survey for immigrant families using a community-based participatory research approach. Data was collected for mood, nutrition, and physical activity.
Results: Adolescents with positive mood drank less regular soda, and demonstrated more minutes, higher levels, and greater social support for physical activity (all ps < 0.05). Adults with positive mood reported more snacking on fruits/vegetables, greater self-efficacy for physical activity, and better physical well-being (all ps < .05). Negative mood was associated with low physical activity level and poor nutritional habits in adolescent and adult immigrants.
Conclusion: Designing community-based programs offering strategies for mood management and healthy lifestyle change may be efficacious for immigrant populations.
Treatment Fidelity Among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families
Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research.
Health Education & Behavior. (2017) 44(2): 262-270.
Background: Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research. Development and implementation of a well-designed treatment fidelity plan, especially with research involving underserved populations, requires careful conceptualization of study needs in conjunction with what is feasible in the population.
Methods: The authors reviewed a fidelity-monitoring plan consistent with the National Institutes of Health Behavior Change Consortium guidelines (e.g., design, training, delivery, receipt, and enactment) for an intervention trial designed to improve physical activity and nutrition among immigrant and refugee families.
Results: Description of the fidelity monitoring plan is provided and challenges related to monitoring treatment fidelity in a community-based participatory intervention for immigrant and refugee families are discussed.
Conclusion: Development and implementation of a treatment fidelity plan, especially among underserved populations, requires careful conceptualization of study needs in conjunction with what is feasible in the population.
Healthy immigrant families: Participatory development and baseline characteristics of a community-based physical activity and nutrition intervention
US immigrants often have escalating cardiovascular risk. Barriers to optimal physical activity and diet have a significant role in this risk accumulation.
Contemporary Clinical Trials. 2015 Dec 4;47:22-31
Background: US immigrants often have escalating cardiovascular risk. Barriers to optimal physical activity and diet have a significant role in this risk accumulation.
Methods: We developed a physical activity and nutrition intervention with immigrant and refugee families through a community-based participatory research approach. Work groups of community members and health scientists developed an intervention manual with 12 content modules that were based on social-learning theory. Family health promoters from the participating communities (Hispanic, Somali, Sudanese) were trained to deliver the intervention through 12 home visits during the first 6months and up to 12 phone calls during the second 6months. The intervention was tested through a randomized community-based trial with a delayed-intervention control group, with measurements at baseline, 6, 12, and 24months. Primary measurements included accelerometer-based assessment of physical activity and 24-hour dietary recall. Secondary measures included biometrics and theory-based instruments.
Results: One hundred fifty-one individuals (81 adolescents, 70 adults; 44 families) were randomized. At baseline, mean (SD) time spent in moderate-to-vigorous physical activity was 64.7 (30.2) minutes/day for adolescents and 43.1 (35.4) minutes/day for adults. Moderate dietary quality was observed in both age groups. Biometric measures showed that 45.7% of adolescents and 80.0% of adults were overweight or obese. Moderate levels of self-efficacy and social support were reported for physical activity and nutrition.
Conclusion: Processes and products from this program are relevant to other communities aiming to reduce cardiovascular risk and negative health behaviors among immigrants and refugees.
A Focus Group Study of Healthy Eating Knowledge, Practices, and Barriers among Adult and Adolescent Immigrants and Refugees in the United States
Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood.
International Journal of Behavioral Nutrition and Physical Activity 2014, 11:63
Background: Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. In this study, we describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States.
Methods: Using a community based participatory research approach, we conducted a qualitative research study with 16 audio-recorded focus groups with adults and adolescents who self-identified as Mexican, Somali, Cambodian, and Sudanese. Focus group topics were eating patterns, perceptions of healthy eating in the country of origin and in the U.S., how food decisions are made and who in the family is involved in food preparation and decisions, barriers and facilitators to healthy eating, and gender and generational differences in eating practices. A team of investigators and community research partners analyzed all transcripts in full before reducing data to codes through consensus. Broader themes were created to encompass multiple codes.
Results: Results show that participants have similar perspectives about the barriers (personal, environmental, structural) and benefits of healthy eating (e.g., ‘junk food is bad’). We identified four themes consistent across all four communities: Ways of Knowing about Healthy Eating (‘Meanings;’ ‘Motivations;’ ‘Knowledge Sources’), Eating Practices (‘Family Practices;’ ‘Americanized Eating Practices’ ‘Eating What’s Easy’), Barriers (‘Taste and Cravings;’ ‘Easy Access to Junk Food;’ ‘Role of Family;’ Cultural Foods and Traditions;’ ‘Time;’ ‘Finances’), and Preferences for Intervention (‘Family Counseling;’ Community Education;’ and ‘Healthier Traditional Meals.’). Some generational (adult vs. adolescents) and gender differences were observed.
Conclusions: Our study demonstrates how personal, structural, and societal/cultural factors influence meanings of food and dietary practices across immigrant and refugee populations. We conclude that cultural factors are not fixed variables that occur independently from the contexts in which they are embedded.
Perspectives on Physical Activity Among Immigrants and Refugees to a Small Urban Community in Minnesota
Immigrants and refugees to the United States exhibit relatively low levels of physical activity, but reasons for this disparity are poorly understood.
Journal of Immigrant and Minority Health, 2015 Feb;17(1):263-75
Background: Immigrants and refugees to the United States exhibit relatively low levels of physical activity, but reasons for this disparity are poorly understood.
Methods: 16 gender and age-stratified focus groups were conducted among 127 participants from heterogenous immigrant and refugee groups (Cambodian, Mexican, Somali, Sudanese) in a small Minnesota urban community.
Results: We found many similarities in perceived barriers and facilitators to physical activity between heterogeneous immigrant and refugee groups. While the benefits of physical activity were widely acknowledged, lack of familiarity and comfort with taking the first steps towards being physically active were the most significant barriers to physical activity. Participants described being motivated by social support from family, friends, and communities to be physically active.
Conclusion: Our findings suggest that shared experiences of immigration and associated social, economic, and linguistic factors influence how physical activity is understood, conceptualized and practiced.
Physical Activity Among Somali Men in Minnesota: Barriers, Facilitators, and Recommendations
Immigrants and refugees arrive to the United States healthier than the general population, but this advantage declines with increasing duration of residence.
American Journal of Men’s Health 2014, 8:35
Background: Immigrants and refugees arrive to the United States healthier than the general population, but this advantage declines with increasing duration of residence. One factor contributing to this decline is suboptimal physical activity, but reasons for this are poorly understood. Persons from Somalia represent the largest African refugee population to the United States, yet little is known about perceptions of physical activity among Somali men.
Methods: Somali members of a community-based participatory research partnership implemented three age-stratified focus groups and three semistructured interviews among 20 Somali men in Rochester, Minnesota. Team-based inductive analysis generated themes for barriers and facilitators to physical activity.
Results: Barriers to physical activity included less walking opportunities in the United States, embarrassment about exercise clothing and lack of familiarity with exercise equipment/modalities, fear of harassment, competing priorities, facility costs, transportation, and winter weather. Facilitators to physical activity included high knowledge about how to be active, success stories from others in their community as inspiration, and community cohesion.
Conclusion: Findings may be used to derive interventions aimed to promote physical activity among Somali men in the United States.
Physical Activity and Nutrition Among Immigrant and Refugee Women: A Community-Based Participatory Research Approach
Immigrant and refugee populations arrive to the U.S. healthier than the general population, but the longer they reside, the more they approximate the cardiovascular risk profiles of the country.
Women’s Health Issues 22-2, 2012, e225-e232
Background: Immigrant and refugee populations arrive to the U.S. healthier than the general population, but the longer they reside, the more they approximate the cardiovascular risk profiles of the country. Among women, these declines are partly mediated by less physical activity and lower dietary quality upon immigration. Given the complex forces that influence these behaviors, a community-based participatory research (CBPR) approach is appropriate. Therefore, a socioculturally responsive physical activity and nutrition program was created with and for immigrant and refugee women in Rochester, Minnesota, through a CBPR approach.
Methods: Focus groups informed program content and revealed principles for designing the sessions. A 6-week program with two, 90-minute classes per week was conducted among 45 women (Hispanic, Somali, Cambodian, and non-immigrant African American). Average attendance was 22.5 women per class; 34 women completed the evaluation.
Results: Evaluation revealed high acceptability (average overall score of 4.85 out of 5 on the Physical Activity Class Satisfaction Questionnaire). After the intervention, participants were more likely to exercise regularly (p .001). They reported higher health-related quality of life (p .001) and self-efficacy for diet (p ¼ .36) and exercise (p ¼ .10). Likewise, there were trends for weight loss (87 vs 83.4 kg; p ¼ .65), decreased waist circumference (99.6 vs 95.5 cm; p ¼ .35), and lower blood pressure (125/80 vs 122/76 mm/Hg; p ¼ .27).
Conclusion: A CBPR approach to design and implement a socioculturally responsive fitness program was highly acceptable to immigrant and refugee women and demonstrated promising outcomes. Further testing of physical activity and nutrition interventions that arise organically from target communities are needed.