Improving Community Access to Nutrition and Physical Activity: On the Web and in the Garden

1. 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.

2. 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.

3. 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

4. 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.

5. 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

6. RHCP CBPR Principles Community initiation, relevance Social Action Outcome Asset-based Iterative Equitable Capacity Building Long-term Sustainability Process Oriented Joint Ownership Varied Methods

7. 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

8. RHCP Today Community 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

9. RHCP Programs and activities Building capacity for community-based qualitative research infrastructure. • Let’s Talk about TB • Tuberculosis at Hawthorne Education Center • Let’s Talk • Community-based Health Literacy Initiative • Club Fit • A formative study of wellness programming at Boys & Girls Club of Rochester • Diabetes Storytelling • Improving Diabetes Care among immigrants and refugees • Healthy Immigrant Families (HIF) • Working Together to Move More and to Eat Well

10. 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)

11. What do you think is the greatest barrier to accessing physical activities in your community? (Choose 1) • Culturally sensitive environments • Childcare • Cost • Transportation • Proximity to home • Time • Other

12. Healthy Immigrant Families Beginnings Health Access Barriers Identified through the Women’s Fitness Program: • Childcare • Cost • Socio-cultural sensitivity • Transportation

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

14. 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

15. 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 Promoters • 2º: Group fitness opportunities • Outcomes: • 1º: Physical activity; Dietary quality • 2º: Weight, body composition, blood pressure, waist-hip ratio, survey questions

16. Healthy Immigrant FamiliesWorkgroups Family Intervention Communication Asset-Based Community Development Qualitative Analysis Family Health Promoter Group Fitness Graduate Nursing

17. 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”

18. Interactive Web-Based Asset Map Group Fitness Communication Development of an interactive web-based community asset map featuring existing physical activity and nutrition resources in Rochester, Minnesota Family Intervention Qualitative Analysis Family Health Promoter Asset-Based Community Development • Attributes • Easily accessible • Family friendly • Ability to filter results based on personal preferences Graduate Nursing

19. Which of the following do you think are most important to your communities when choosing physical activity opportunities? (Rank your top 3) Women only or Men only Family oriented Group oriented Indoor Outdoor Cost Childcare availability Proximity to home Type of physical activity Other

20. Interactive Web-Based Asset Map • Community Assets • Individual Community and Research Volunteers • Met in a weekly workgroup to discuss, plan the features and capabilities, and develop the asset map • Existing Physical Assets • Worked together to identify existing physical activity and nutrition resources • Institutional and Individual Consultations • Utilized 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 Feedback • Asset 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

21. Asset Map Components • Physical 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

22. Healthy Immigrant Families Beginnings Health Access Barriers Identified: Childcare Cost Socio-cultural sensitivity Transportation

23. Asset Map Components • Community assets addressing childcare, cost, and cultural sensitivity. • Insert screen shot of category options

24. This is a store with fresh produce: True False Uncertain

25. Asset Map Components • Community nutrition assets addressing cost and cultural acceptance. • Insert screen shot of category options– nutrition • Exhibit categories selected, and show screen shots

26. Healthy Immigrant Families Beginnings Health Access Barriers Identified: Childcare Cost Community Transportation

27. Asset Map Components • Addressing transportation barriers– bus routes, bike routes, and walking friendly routes to come. • Insert screen shot of category options

28. 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.

29. Questions?

30. Thank You!RHCP would like to honor all the volunteers and individual members who have dedicated time to the asset map. Healthy Immigrant Families Spring Summit