Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience
Community-based participatory research (CBPR) can effectively address health disparities among groups that are historically difficult to reach, disadvantaged, of a minority status, or are otherwise underrepresented in research. Recent research has focused on the science of CBPR partnership constructs and on developing and testing tools for self-evaluation.
Progress in Community Health Partnership: Research, Education, and Action, Volume 15, Issue 2, Summer 2021, pp. 161-175
Abstract
Background: Community-based participatory research (CBPR) can effectively address health disparities among groups that are historically difficult to reach, disadvantaged, of a minority status, or are otherwise underrepresented in research. Recent research has focused on the science of CBPR partnership constructs and on developing and testing tools for self-evaluation. Because CBPR requires substantial investment in human and material resources, specific factors that support successful and sustainable research partnerships must be identified. We sought to describe the evolution, implementation, and results of a self-evaluation of a CBPR partnership.
Methods: Academic and community members of the Rochester Healthy Community Partnership (RHCP) and researchers from the University of New Mexico-Center for Participatory Research collaborated to evaluate RHCP with qualitative and quantitative research methods and group analysis.
Results: The self-evaluation was used to provide an overall picture of the "health" of the partnership, in terms of sustainability and ability to effectively collaborate around community priorities. RHCP members revisited the partnership's mission and values; identified associations between partnership practices, dynamics, and outcomes; and elicited insight from community and academic partners to help guide decisions about future directions and the sustainability of the partnership. Positive partnership dynamics were associated with perceived improvements in health and equity outcomes.
Conclusions: Although engaging in a comprehensive self-evaluation requires substantial investment from stakeholders, such assessments have significant value because they enable partners to reflect on the mission and values of the partnership, explore the history and context for its existence, identify factors that have contributed to outcomes, and plan strategically for the future.
An Assessment of Health Priorities Among a Community Sample of Somali Adults.
Health priorities for the Somali population in the United States (US) have been changing since their arrival to the US in the early 1990s.
Journal of Immigrant and Minority Health. March 2021.
Abstract
Background: Health priorities for the Somali population in the United States (US) have been changing since their arrival to the US in the early 1990s. Somali populations have consistently been in the top three total number of African refugees immigrating to the United States over the past three decades and were the second largest group of refugees from Africa in 2019.
Methods: This study was conducted in 2018 as part of a larger RHCP survey of Somali participants. The purpose of the survey was to assess the effects of social networks on weight and obesogenic behaviors [19]. Because the planned survey was among the largest reported with a community sample of Somalis, RHCP community partners advocated for an embedded assessment of health priorities more broadly. This was a CBPR study where community and academic members of RHCP worked together in all phases of the study.
Results: A total of 646 participants responded to the survey. The majority (93%) of participants were born outside of the US. The mean age was 37.9 years with 43% female. The majority (66%) had a high school level education or less. Annual family income was less than $50,000 for 92% of participants and 90% had health insurance in the last 12 months.
Conclusion: The findings of this study show a significant overlap of health priorities among Somali individuals and their families compared to perceived priorities for the community as a whole. Health behaviors related to diet and exercise, diabetes, obesity, and hypertension were considered higher priorities than infectious diseases. These health priorities underscore the need for Somali health partnerships to focus on non-communicable diseases.
Community-Engaged Approaches for Minority Recruitment Into Clinical Research: A Scoping Review of the Literature.
Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideal of generalizability and equity of research findings and products.
Mayo Clinic Proceedings. September 2020.
Abstract: Underrepresentation of racial and ethnic minority populations in clinical research persists in the United States, highlighting the unmet ideals of generalizability and equity of research findings and products. Previous systematic reviews exploring various facets of this phenomenon concluded that community engagement with minority groups may effectively promote recruitment and retention, but the ways in which community-engaged approaches have been used for recruitment have not been examined. We performed a scoping review of the literature to identify studies of community-engaged recruitment processes. The search resulted in 2842 articles, of which 66 met inclusion criteria. These articles demonstrated a relatively large literature base of descriptive studies conveying details of community engagement approaches to enhance recruitment of minority research participants. We summarize key aspects of current practices across the spectrum of community engagement. A gap in the literature is the relative lack of the comparative studies among different engagement strategies.
Lay health worker as interventionist training: reflective writing in US family health promotion practice.
Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals.
Health Promotion International. February 2021.
Abstract: Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.
The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States.
Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes.
Clinical Infectious Diseases. February 2021.
Abstract: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. Although the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.
Emergency Preparedness and Risk Communication Among African American Churches: Leveraging a Community-Based Participatory Research Partnership COVID-19 Initiative
Partnerships with faith-based organizations are pivotal in rapidly engaging with racial/ethnic minority populations, who are often socially and economically marginalized and medically underserved, to address public health crises.
Preventing Chronic Diseases. December 2020.
Abstract: The coronavirus disease 2019 (COVID-19) crisis has disproportionately affected the African American population. To mitigate the disparities, we deployed an emergency preparedness strategy within an existing community-based participatory research (CBPR) partnership among African American churches to disseminate accurate COVID-19 information. We used the Centers for Disease Control and Prevention Crisis and Emergency Risk Communication framework to conduct a needs assessment, distribute emergency preparedness manuals, and deliver COVID-19-related messaging among African American churches via electronic communication platforms. A needs assessment showed that the top 3 church emergency resource needs were financial support, food and utilities, and COVID-19 health information. During an 8-week period (April 3-May 31, 2020), we equipped 120 churches with emergency preparedness manuals and delivered 230 messages via social media (Facebook) and email. For reach, we estimated that 6,539 unique persons viewed content on the Facebook page, and for engagement, we found 1,260 interactions (eg, likes, loves, comments, shares, video views, post clicks). Emails from community communication leaders reached an estimated 12,000 church members. CBPR partnerships can be effectively leveraged to promote emergency preparedness and communicate risk among under-resourced communities during a pandemic.
Community Engagement With Vulnerable Populations
The coronavirus disease 2019 (COVID-19) pandemic has impacted vulnerable populations disproportionately, including those affected by socioeconomic disadvantage, racial discrimination, low health literacy, immigration status, and limited English proficiency. African Americans, Hispanics, and Native Americans are dying at considerably higher rates across the country than whites.
Mayo Clinic Proceedings. Volume 95, Issue 9. September 2020.
Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted vulnerable populations disproportionately, including those affected by socioeconomic disadvantage, racial discrimination, low health literacy, immigration status, and limited English proficiency. African Americans, Hispanics, and Native Americans are dying at considerably higher rates across the country than whites.
Conclusion: The social and structural determinants of health have been understood for decades, and such determinants are also relevant to the disparities in health care that are exacerbated by the current COVID-19 crisis. The focus of multisector collaboration and community engagement should be to inform programs and policies that will eliminate the disproportionate impact of pandemics on vulnerable communities. Indispensable to such initiatives are collaborative, community-led solutions in removing structural barriers to health equity that currently exist.
Facilitated Stories for Change: Digital Storytelling as a Tool for Engagement in Facilitated Discussion for Reduction of Diabetes-Related Health Disparities Among Rural Latino Patients With Diabetes
Latino populations, especially those living in rural areas, experience a disproportionately high prevalence of type 2 diabetes mellitus. They are also less likely to achieve optimal glycemic control and have 1.5 times higher age adjusted diabetes related mortality rate than non-Hispanic Whites.
SAGE Publishing and Journal of Transcultural Nursing. 22 December 2020
Background: Latino populations, particularly those living in rural areas, experience a disproportionately high prevalence and poorer outcomes of type 2 diabetes mellitus (T2DM). The purpose of this study was to test the acceptability and perceived effectiveness of a group-based, facilitated digital storytelling intervention for T2DM self-management among rural Latino patients.
Methods: Twenty Latino adults with T2DM participated in facilitated storytelling discussions at two primary clinics. Participants viewed a 12-minute T2DM self-management digital storytelling intervention, followed by a facilitated group discussion. Surveys, observations, and focus groups were used to assess for acceptability and perceived effectiveness of the intervention through descriptive and qualitative analysis, informed by narrative and social cognitive theory.
Results: All participants found the intervention interesting and useful and reported improvement in confidence, motivation, and behavioral intentions for T2DM self-management. Themes mapped closely with narrative theory models, further suggestive of the behavior change potential.
Conclusion: Facilitated discussions may add value to viewing of digital stories and represent a scalable approach to provide culturally congruent health care for Latino patients with diabetes in rural settings. Within the paradigm of group-based diabetes educational programs, this lends itself well to critical transcultural nursing care.
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.
Leveraging community engaged research partnerships for crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic
Crisis and emergency risk communication frameworks are currently being applied in the public health response to the coronavirus disease 2019 (COVID-19) pandemic to encourage public participation in disease containment. Common principles of these frameworks are to be correct, credible and respectful, to promote action and to engage with communities in order to empower decision making.
Journal of Clinical and Translational Science. 15 May 2020
Background: This study aims to demonstrate the use of a CEnR health partnership with vulnerable populations leveraging its social networks, credibility, and technical expertise to promote bidirectional crisis and emergency risk communication for the COVID-19 pandemic.
Vulnerable populations and minorities are more likely to have communication gaps due to socioeconomic disadvantage, low health literacy, immigration status, and limited English proficiency,5 compounded by language and cultural discordance and mistrust of health institutions.6 The Centers for Disease Control and Prevention (CDC) Crisis and Emergency Risk Communication Manual describes three levels of community engagement (low, medium, high), and acknowledges that a high level of engagement that starts prior to any emergency is needed to reach vulnerable populations in times of crisis.
Methods: Community and academic partners from Rochester Healthy Community Partnership (RHCP), a CEnR partnership with a 15-year history of participatory research with immigrant populations in Southeast Minnesota,9 adopted the CDC Crisis and Emergency Risk Communication framework for co-creation of an intervention framework aimed at populations with limited English proficiency. RHCP community partners observed that credible COVID-19 information was being produced, but it was not reaching immigrant communities.
Results: The intervention was delivered by 24 Communication Leaders (11 Somali, 6 Hispanic, 2 Cambodian, 3 South Sudanese, 1 Anuak, 1 Ethiopian). In addition to the 3 main message maps, 8 COVID-19 updates were translated and disseminated. In addition to bidirectional communication between all partners on daily telephone conferences, 40 emails, text messages or phone calls were sent to Communication Leaders in response to new COVID-19 developments or community concerns.
Conclusion: By leveraging existing networks and credibility, CEnR partnerships may effectively implement crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic.
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.
Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency
Nine percent of the US population has limited English proficiency (LEP), which is defined by the US Census Bureau as speaking English “less than very well.” LEP is an important mediator of health disparities and has been linked to overall poor health and low quality of healthcare delivery, decreased understanding of medical information, and dissatisfaction with care.
Journal of Cancer Education. 2020 Feb 12
Background: Nine percent of the US population has limited English proficiency (LEP), which is defined by the US Census Bureau as speaking English “less than very well.” LEP is an important mediator of health disparities and has been linked to overall poor health and low quality of healthcare delivery, decreased understanding of medical information, and dissatisfaction with care. Compared with patients who speak English well, LEP is associated with suboptimal disease-specific outcomes across multiple chronic conditions. These disparities are only partially mitigated by appropriate use of medical interpreters or provision of language-concordant providers.
Methods: This study employed a participatory formative evaluation approach, which included aspects of needs assessment, as well as engagement of potential users in intervention development in order to enhance usefulness and relevance. This study was approved by the (Mayo Clinic) Institutional Review Board (IRB #17–009432).
Results: Interviews were completed with 9 patients, 5 providers, 5 interpreters, and 3 (Cambodian, Hispanic, and Somali) community leaders. The median interview duration was 28 min (range 18–57). Patients and interpreters represented Cambodian, Somali, Spanish, and Vietnamese languages. Spanish (n = 2) and Somali (n = 6) patient interviews were conducted by bilingual study staff, while interviews in Cambodian (n = 1) and Vietnamese (n = 1) were conducted with the assistance of an interpreter. Themes from interviews were aligned with the constructs in the National Cancer Institute SEM.
Conclusion: These findings demonstrate that it is possible to engage a diverse group of stakeholders in strategies that are responsive to health care providers and patients, including LEP patients from heterogeneous backgrounds. Participatory methods of intervention planning furthered our understanding of study findings and engaged individuals to move projects from research to implementation. Next steps for this study team involve community-academic intervention implementation in the community and clinic settings.
The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model...
Established community-based participatory research (CBPR) partnerships need tools to assist with self-evaluation of the effectiveness and engagement with CBPR principles and to inform ongoing work. A growing part of the CBPR field is focused on the evaluation of partnering processes and outcomes.
Program Community Health Partnership: Research, Education and Action, 2019;13(3):225-235
Background: Established community-based participatory research (CBPR) partnerships need tools to assist with self-evaluation of the effectiveness and engagement with CBPR principles and to inform ongoing work. A growing part of the CBPR field is focused on the evaluation of partnering processes and outcomes.
Methods: We collaboratively developed and implemented a facilitated self-evaluation using adaptations of existing tools and the CBPR conceptual model. Partners contributed through surveys and qualitative interviews. Initially, data were analyzed collaboratively by members of RHCP and UNM-CPR, but RHCP partners further processed and consolidated findings, leading to the development of key questions that guided a full partnership discussion of action steps.
Results: Our process confirmed the adaptability of existing tools and the CBPR conceptual model for the purpose of partnership reflection and self-evaluation. We offer the key findings of our assessment of partnering practices and directions for the future, and share our approach to collaborative analysis and dissemination. Our discussion includes lessons learned, with applicability to other established partnerships.
Conclusion: Our experience indicates that collective reflection is empowering for members of established partnerships, which can be facilitated by engagement in self-evaluation through the use of adapted, available tools. The incorporation of participatory processes adds complexity, but leads to a level of resonance and usefulness that would not have been obtained from a traditional evaluation.
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.
Sustainability of a Tuberculosis Screening Program at an Adult Education Center Through Community-Based Participatory Research
The majority of active tuberculosis (TB) cases in the United States occur through reactivation of latent TB infection among foreign-born individuals. While screening of at-risk individuals through community partnerships is recommended, it is not commonly accomplished.
Journal of Public Health Management and Practice. Nov/Dec 2019;25(6):602-605
Background: Approximately two-thirds of active tuberculosis (TB) cases in the United States occur in foreign-born individuals, predominantly through reactivation of latent TB infection (LTBI) in the first 5 to 10 years after arrival.1 The US guidelines recommend testing for and treating LTBI among people from countries where TB is common.2 Immigrants arrive to the United States in a variety of ways, which precludes a uniform system of detection such that most immigrants diagnosed with active TB in one study never received prior LTBI testing in the United States.3 To overcome the multifaceted barriers to screening in these populations, the Centers for Disease Control and Prevention recommends forging community partnerships within at-risk communities to prevent TB in the United States,4 but perhaps due to limited resource allocation, these partnerships have not been prevalent.
We describe the sustainability of a TB-screening intervention at an adult education center that serves a large foreign-born population at risk for the disease. Sustainability is defined as a program continuing to be delivered after a defined period of time while adapting in order to continue producing benefits for individuals.5 Sustainability planning has been highlighted as an underdocumented yet core component of the dissemination and implementation of successful health promotion interventions.5–7
The TB-screening intervention, derived through a community-based participatory research approach from 2006 to 2009,8 was found to be feasible, worthwhile, and superior to previous conventional screening programs at the same site.9 Intervention development and cross-sectional evaluation were grant-funded. Here, we describe the longitudinal implementation of the intervention, from 2009 to 2017, through participatory mechanisms that extended beyond the funding period.
Methods:
Setting and participants
The TB-screening program takes place at Hawthorne Education Center, the adult education center for the Rochester (Minnesota) public school district. In addition to serving its primary purpose as a school, Hawthorne contains features of a community center, providing a health clinic, instruction for social and environmental adjustment after immigration, citizenship, and financial counseling, among other services.
Hawthorne serves a large foreign-born population through English language classes and other programs. More than 70 languages are spoken at home among approximately 2500 Hawthorne learners; 85% live below the federal poverty level. Most Hawthorne learners have elevated TB risk, including recent emigration from regions of the world where TB is endemic, including sub-Saharan Africa, Latin America, and Southeast Asia.
Partnership description
Hawthorne is the founding community partner of Rochester Healthy Community Partnership (RHCP), which has a mission to promote health through community-based participatory research.10 Community-based participatory research is an approach to research where community and academic partners work together in an equitable fashion through every phase of the research process.11 Since its inception in 2004, RHCP has become productive and experienced at deploying data-driven programming and evaluation with immigrant populations.10
In 2006, Hawthorne leaders approached RHCP academic partners to address the concern of TB at the school. Several cases of active TB had been diagnosed among Hawthorne learners, prompting an environment of fear and TB-related stigma. Previous attempts at voluntary TB screening at Hawthorne resulted in very low participation rates (<10 per session). RHCP partners collaboratively explored the mechanisms of these health-seeking behaviors with Hawthorne learners and staff.8 This precipitated an effective partnership between Hawthorne learners and staff, academic partners, and the local public health department to initiate and sustain a TB-screening program at the school.
Intervention
Longitudinal implementation of the intervention was based on lessons learned from initial screening of 259 Hawthorne learners in 2009.9 Prior to every screening opportunity, members of the Hawthorne staff, Olmsted County TB Clinic (situated at the Olmsted County Public Health Department), and/or nursing students from Winona State University conducted approximately 15 minutes of TB education in each classroom. This included the viewing of a 7-minute TB education video that was previously developed and tested by RHCP at Hawthorne.12 Facilitators then described TB-testing procedures at Hawthorne, answered questions, and left a sign-up sheet in the classroom. In total, these discussions served to propagate the atmosphere of open dialogue around TB at Hawthorne in the face of learner turnover that is typical for adult education centers from year to year.
Names from the sign-up sheets were shared with the TB clinic, which cross-referenced names with a database. Those who had recent TB skin tests, who had previous positive test results, and/or who had been treated for TB were informed by TB clinic staff that they would not be retested in this screening program. Students who were eligible for TB screening after TB clinic review were contacted by Hawthorne staff to provide them with the date and time of TB screening. Screening took place at the school in response to a strong preference among learners to conduct the test in that safe and convenient space.
Tuberculosis skin testing was performed according to the Centers for Disease Control and Prevention guidelines13; a positive test was recorded for skin reactions of 10 mm or larger. The skin tests were administered and read by trained registered nurses from the TB clinic. Individuals with positive tests were immediately counseled, and appointments were made at the TB clinic, where subsequent diagnostic and therapeutic interventions, including a clinical examination, chest radiography, and 9 months of isoniazid therapy were delivered at no cost to the student.
Data analysis
The following data were collected by Olmsted County TB Clinic staff for each individual screened for TB at Hawthorne: TB skin test result, patient seen at the Olmsted County TB Clinic (Y/N), result of interferon-gamma release assay test (if applicable), LTBI medication started (Y/N), and LTBI medication completed (Y/N). These results were stored in a secure registry that is maintained for the clinic. Results were reported using descriptive statistics. Analysis and dissemination of these data were approved by the Mayo Clinic Institutional Review Board.
Results:
The results of the TB-screening program from 2009 to 2017 are shown in the Table. Among more than 618 tests completed at Hawthorne during this interval, 121 tests were positive. Among these patients with positive test results, 101 completed evaluation at the public health department, and all patients were ruled out for active disease. Seventy-two patients were started on medication for LTBI; 57 of these patients have completed the medications to date. The reasons for not treating the additional 19 patients who completed evaluation included negative interferon-gamma release assay testing, medical contraindication to therapy, pregnancy, or patient choice to decline the medication.
Conclusion:
This case study demonstrates a framework for sustaining partnerships to address TB prevention among communities at risk for the disease. Adult education centers that serve large foreign-born populations are effective venues for this partnership work. A participatory approach with stakeholders helps sustain these TB prevention efforts.
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.
Pilot Feasibility Study of a Digital Storytelling Intervention for Immigrant and Refugee Adults With Diabetes
Immigrants and refugees often arrive in the United States healthier than most Americans, but with time, their health becomes similar to that of the general population, including with regard to unhealthy cardiovascular risk factors and incidence of type 2 diabetes mellitus (T2DM).
The Diabetes Educator 2017 43(4):349-359
Background: The purpose of this pilot feasibility study was to examine the potential effectiveness of a digital storytelling intervention designed through a community-based participatory research (CBPR) approach for immigrants and refugees with type 2 diabetes mellitus (T2DM).
Methods: The intervention was a 12-minute culturally and linguistically tailored video consisting of an introduction, four stories, and a concluding educational message. A structured interview was used to assess the intervention for acceptability, interest level, and usefulness among 25 participants with T2DM (15 Latino, 10 Somali) across five primary care clinical sites. After watching the video, participants rated their confidence and motivation about managing T2DM as a result of the intervention. Baseline hemoglobin A1C and follow-up values (up to six months) were abstracted from medical records.
Results: All participants reported that the intervention got their attention, was interesting, and was useful. 96% reported that they were more confident about managing their T2DM than before they watched the video, and 92% reported that the video motivated them to change a specific behavior related to T2DM self-management. The mean baseline A1C level for the intervention participants was 9.3% (78 mmol/mol). The change from baseline to first follow-up A1C level was -0.8% (-10 mmol/mol) (p < 0.05).
Conclusion: Implementation of a digital storytelling intervention for T2DM among immigrant populations in primary care settings is feasible and resulted in self-rated improvement in psychosocial constructs that are associated with healthy T2DM self-management behaviors, and there was some evidence of improvement in glycemic control. A large-scale efficacy trial of the intervention is warranted.
Diabetes Knowledge, Attitudes and Behaviors Among Somali and Latino Immigrants
Persons from Somalia constitute the largest group of immigrants and refugees from Africa among whom diabetes-related health disparities are well documented.
Journal of Immigrant and Minority Health. (2016 ) 18(6): 1432-1440.
Background: Persons from Somalia constitute the largest group of immigrants and refugees from Africa among whom diabetes-related health disparities are well documented.
Methods: As one of the first steps toward developing a behavioral intervention to address diabetes among Somali immigrants and refugees, we administered a face to face interview-based survey to Somali and Latino adults with diabetes in a single community to assess diabetes knowledge, attitudes and behaviors.
Results: Respondents (N = 78) reported several barriers to optimal diabetes management for physical activity and glucose self-monitoring, as well as a high burden of disease and negative perceptions of diabetes. High participant engagement in disease management, self-efficacy, and social support were important assets. Similarities suggest that the shared experiences of immigration and related systemic socioeconomic and linguistic factors play a significant role in the understanding and self-management of diabetes in these populations.
Conclusion: Together with previously collected qualitative work, the survey findings will inform development of a behavioral intervention to improve outcomes and reduce diabetes-related health disparities among immigrant and refugee groups to the U.S.