C2DREAM #1

Diseases Being Studied: Cardiovascular Risk & Obesity
Communities of Focus: Somali and Hispanic communities
Regional Partners, Stakeholders: Mayo Clinic in Rochester, MN​ and Rochester Healthy Community Partnership (RHCP)
Study Site: Southern Minnesota

Study Objectives: Assess the efficacy of a social network-informed CBPR-derived health promotion intervention on obesity and cardiovascular risk
Intervention: Social network intervention of 12 community-based mentoring and education sessions, followed by 12 maintenance sessions given by Health Promoters over 1 year to members of their social networks

Abstract

Across many measures, immigrant populations arrive to the US healthier than the general population, but the longer they reside in the US, the more their cardiovascular risk rises, mediated in part by systemic factors that promote the adoption of unhealthy behaviors. Given the complex sociocultural forces that influence these behaviors, a community-based participatory research (CBPR) approach is needed to address them. Rochester Healthy Community Partnership (RHCP) is a CBPR partnership experienced at collectively deploying interventions with immigrant groups. RHCP tested an intervention of 12 face-to-face modules to promote healthy behaviors within immigrant populations. At 12 months, there were significant improvements in the primary outcome of dietary quality compared with controls, suggesting this program could meet the unique needs of immigrant communities. However, the intervention intensity limits its dissemination potential, and the intervention did not explicitly address healthful weight loss, nor target overweight or obese participants. Subsequently, a social network (SN) analysis of 1,301 Hispanic and Somali adults found that obesity and behaviors clustered by ascertainable SNs. RHCP partners then re-designed existing intervention materials for overweight and obese adults from immigrant communities to be delivered by peer interventionists within their social networks.

The resultant social network intervention was pilot tested with 4 groups (2 Somali, 2 Hispanic; total N=39); participants demonstrated significant reduction in weight, blood pressure, and cholesterol as well as improvements in their dietary quality and physical activity at 3 months (100% retention rate). Building on this, our overall objective is to foster sustainable health promotion for Southeast Minnesota immigrant communities.

Specific Aims

The aims of this program are to: 1) assess the efficacy of a social network-informed CBPR-derived health promotion intervention on obesity and other measures of cardiovascular risk in two immigrant communities; and, 2) assess the impact on sustainability and uptake outcomes of embedding the intervention within a regional health promotion resource hub. Using a stepped wedge cluster randomized design, 46 social network sub-groups of adults (23 Hispanic, 23 Somali) with approximately 322 participants (7 per group) will be randomly assigned to receive the intervention either immediately or after a delay of one year.

The intervention will consist of 12 community-based mentoring and education sessions, followed by 12 maintenance sessions delivered by trained Somali and Hispanic interventionists to members of their groups in a face-to-face or virtual format. Outcomes measured through 24 months, will be 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. This program will mobilize the power of SNs for scalable and sustainable solutions to obesity-related behaviors among difficult to reach populations. CBPR enhances the relevance of this program by targeting socio-cultural determinants of these behaviors.