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Improving Community Access to Nutrition and Physical Activity: On the

Web and in the Garden

On the Web:

Carrie Bergstralh, Rochester Healthy Community Partnership, Minnesota, U.S.

In the Garden:

Nadine Braunstein, Towson University, Maryland, U.S.

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Development of an Interactive Web-Based Physical Activity and Nutrition Asset Map to Reduce Health Access

Barriers for Refugees and Immigrants

Carrie Bergstralh

Rochester Healthy Community Partnership, Rochester, MN, U.S.

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Objectives

• Describe the Rochester Healthy Community Partnership (RHCP)

• Beginning Healthy Immigrant Families (HIF)

• Health access barriers identified by the Rochester community

• Why asset mapping?

• Development of an interactive web-based physical activity and nutrition asset map

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Rochester Healthy Community Partnership (RHCP) Mission

Promote health and well-being among the Rochester population through:

• community-based participatory research

• education

• civic engagement

to achieve health for all.

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Community-Based Participatory Research (CBPR)

• A collaborative process of research.-Engages community members.-Employs local knowledge to understand health problems and design interventions.-Invests community members in the processes and products of research.

• Goal: Reduce health disparities.

~Agency for Healthcare Research & Quality

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RHCP CBPR Principles

Social Action

Outcome

Long-term Sustainability

Joint Ownership Varied

Methods

Process Oriented

Equitable

Capacity Building

Community initiation, relevance

Asset-basedIterative

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Rochester Healthy Community Partnership Beginnings

• Started in 2004 between Hawthorne Education Center and Mayo Clinic

• Initial health concern/research topic:Tuberculosis at Hawthorne

• Hawthorne Education Center-Rochester Adult and Family Literacy-2,000 adult learners from Sub-Saharan Africa, Latin America, Southeast Asia and Southeast Minnesota-70 different languages spoken at home-85% live below federal poverty level

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RHCP Today

• Mayo Clinic

• University of Minnesota Rochester

• Winona State University Rochester

• Olmsted Medical Center

• Rochester Community and Technical College

Academic

• Hawthorne Education Center

• Church of St. John

• Somali Community Resettlement Services

• Association of Chicanos, Hispanics and Latin Americans

• Cambodian Association of Rochester Minnesota

• Cambodian Buddhist Temple

• Multicultural Learning Center

• New Sudan American Hope

• Boys and Girls Club of Rochester

• Rochester Area YMCA

• Olmsted County Public Health Services

• Vision Church

Community

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RHCP Programs and activitiesBuilding capacity for community-based qualitative research infrastructure.

•Let’s Talk about TBTuberculosis at Hawthorne Education Center

•Let’s TalkCommunity-based Health Literacy Initiative

•Club FitA formative study of wellness programming at Boys & Girls Club of Rochester

•Diabetes StorytellingImproving Diabetes Care among immigrants and refugees

•Healthy Immigrant Families (HIF)Working Together to Move More and to Eat Well

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HIF Beginnings:Women’s Fitness Program

• Community-informed fitness pilot for immigrant and refugee women.

-6 week program with twice weekly classes.-60 minutes exercise.-30 minutes nutrition education.

• Evaluated with 34 women.-Improved health behaviors, attitudes, and biometrics.

• Obtained preliminary data for NIH grant application to improve physical activity and dietary quality among immigrant and refugee families.Wieland, ML., et al. Women's Health Issues , 2012, 22(2):225-32.Funding: Mayo Clinic Center for Translational Science Activities (CTSA)

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What do you think is the greatest barrier to accessing physical activities in your community? (Choose 1)

1. Culturally sensitive environments

2. Childcare

3. Cost

4. Transportation

5. Proximity to home

6. Time

7. Other

Cultura

lly se

nsitive

envi...

Childca

reCost

Transp

ortation

Proxim

ity to

homeTim

eOth

er

0% 0% 0% 0%0%0%0%

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Healthy Immigrant Families Beginnings

Health Access Barriers Identified through the Women’s Fitness Program:

1. Childcare

2. Cost

3. Socio-cultural sensitivity

4. Transportation

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Healthy Immigrant Families Working together to move more and to eat well

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Healthy Immigrant Families

• Funding: National Institutes of Health

• Goal: Improve the health of immigrants and refugees

• Hypothesis: Community-derived family-focused culturally-appropriate intervention will improve physical activity and dietary behaviors among immigrants and refugees in Rochester, MN

• Aims:1: Develop a physical activity and nutrition

intervention 2: Evaluate intervention efficacy

• Participating communities: Somali, Hispanic, Cambodian, Sudanese

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Healthy Immigrant Families• Approach: CBPR

• Design: Randomized community-based trial with delayed intervention control group

• Intervention:1º: Community-based, individualized, family-focused behavior-change intervention.

-Informed by evidence-based resources and focus group results

-Delivered by Family Health Promoters2º: Group fitness opportunities

• Outcomes:1º: Physical activity; Dietary quality2º: Weight, body composition, blood pressure, waist-hip ratio, survey questions

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Healthy Immigrant FamiliesWorkgroups

Asset-Based Community

Development

Group Fitness

Graduate Nursing

Family Health

Promoter

Qualitative Analysis

Family Intervention

Communication

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Why Asset Mapping?

Encourage use of existing community nutrition and physical activity resource assets by increasing awareness, working with families to find solutions to barriers, and increasing participant self-efficacy through “family learning sessions”

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Interactive Web-Based Asset Map

Family Intervention

Asset-Based Community

Development

Graduate Nursing

Family Health

Promoter

Qualitative Analysis

Group Fitness

Communication

Development of an interactive web-based community asset map featuring existing physical activity and nutrition resources in Rochester, Minnesota

Development of an interactive web-based community asset map featuring existing physical activity and nutrition resources in Rochester, Minnesota

Attributes•Easily accessible•Family friendly•Ability to filter results based on personal preferences

Attributes•Easily accessible•Family friendly•Ability to filter results based on personal preferences

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Which of the following do you think are most important to your communities when choosing physical activity opportunities? (Rank your top 3)

1. Women only or Men only

2. Family oriented

3. Group oriented

4. Indoor

5. Outdoor

6. Cost

7. Childcare availability

8. Proximity to home

9. Type of physical activity

10. Other 1. 2. 3. 4. 5. 6. 7. 8. 9.

0% 0% 0% 0% 0%0%0%0%0%

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Interactive Web-Based Asset Map

Community AssetsIndividual Community and Research VolunteersMet in a weekly workgroup to discuss, plan the features and capabilities, and develop the asset map

Existing Physical AssetsWorked together to identify existing physical activity and nutrition resources

Institutional and Individual ConsultationsUtilized both formal and informal networks to determine individuals who could assist with technical aspects of the project (i.e. data survey collection instruments for sustainability and software development)

Community FeedbackAsset map layout presented to the larger community via a “Project Summit,” where community leaders and members provided feedback and recommendations to ensure cultural and social acceptability

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Asset Map ComponentsPhysical Activity

•Socio-cultural: Women Only, Men Only, Co-Ed•Family friendly: Adults, Teens, Adolescents, Youth, Family Oriented, Group •Weather: Indoor, Outdoor•Seasonal: Winter, Spring, Summer, Fall•Cost: Fees (if any), Memberships, Scholarships•Childcare Availability and Cost•Search by Activities

Nutrition•Socio-cultural: Ethnic Groceries with Fresh Produce•Cost: Farmers Market

Food Shelves/Food Pantries Community Gardens Accepts EBT or WIC

•Dietetic services available

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Healthy Immigrant Families Beginnings

Health Access Barriers Identified:

1. Childcare

2. Cost

3. Socio-cultural sensitivity

4. Transportation

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Asset Map ComponentsCommunity assets addressing childcare, cost, and

cultural sensitivity.

Insert screen shot of category options

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This is a store with fresh produce:

1. True

2. False

3. Uncertain

1. 2. 3.

0% 0%0%

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Asset Map ComponentsCommunity nutrition assets addressing cost and

cultural acceptance.

Insert screen shot of category options– nutrition

Exhibit categories selected, and show screen shots

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Healthy Immigrant Families Beginnings

Health Access Barriers Identified:

1. Childcare

2. Cost

3. Community

4. Transportation

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Asset Map ComponentsAddressing transportation barriers– bus routes, bike

routes, and walking friendly routes to come.

Insert screen shot of category options

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Asset Mapping Sustainability

By using an asset-based approach, and connecting participants to existing community resources, we hope to foster sustainable barrier reduction to health access beyond the end of the study and for the community at large.

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Questions?

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Thank You!RHCP would like to honor all the

volunteers and individual members who have dedicated time to the asset map.

Healthy Immigrant FamiliesSpring Summit