Background Immigrant and refugee populations arrive to the US 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, MN 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). Average attendance was 22.5 women per class; 34 women completed evaluation. Results Evaluation revealed high acceptability (average overall score of 4.85 out of 5 on the Physical Activity Class Satisfaction Questionnaire). Following the intervention, participants were more likely to exercise regularly (p=<0.001). They reported higher health-related quality of life (p=<0.001) and self-efficacy for diet (p=0.36) and exercise (p=0.10). Likewise, there were trends for weight loss (87 kg vs. 83.4 kg; p=0.65), decreased waist circumference (99.6 cm vs. 95.5 cm; p=0.35), and lower blood pressure (125/80 mm/Hg vs. 122/76 mm/Hg; p=0.27). Conclusions 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.

Tuberculosis (TB) disproportionately affects immigrants and refugees to the United States. Upon arrival to the US, many of these individuals attend adult education centers, but little is known about how to deliver TB health information at these venues. Therefore, a participatory approach was used to design and evaluate a tuberculosis education video in this setting. Focus groups data were used to inform the content of the video that was produced and delivered by adult learners and their teachers. The video was evaluated by learners for acceptability through 3 items with a 3-point Likert scale. Knowledge (4 items) and self-efficacy (2 items) about TB were evaluated before and after viewing the video. A total of 159 learners (94%) rated the video as highly acceptable. Knowledge about TB improved after viewing the video (56% correct vs. 82% correct; p=<0.001), as did TB-related self-efficacy (77% vs. 90%; p=<0.001). Adult education centers that serve large immigrant and refugee populations may be excellent venues for health education, and a video may be an effective tool to educate these populations. Furthermore, a participatory approach in designing health education materials may enhance the efficacy of these tools.

Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capacity and evidence on dementia care and services in Brazil, Indonesia, India, Jamaica, Kenya, Mexico and South Africa. This article presents the Theory of Change (ToC) approach we used to co-design our research project and to develop a strategic direction for dementia care, treatment and support, with stakeholders. ToC makes explicit the process underlying how a programme will achieve its impact. We developed ToCs in each country and across the STRiDE project with researchers, practitioners, people living with dementia, carers and policymakers at different levels of government. This involved (1) an initial ToC workshop with all project partners (43 participants); (2) ToC workshops in each STRiDE country (22–49 participants in each); (3) comparison between country-specific and overall project ToCs; (4) review of ToCs in light of WHO dementia guidelines and action plan and (5) a final review. Our experiences suggest ToC is an effective way to generate a shared vision for dementia care, treatment and support among diverse stakeholders. However, the project contribution should be clearly delineated and use additional strategies to ensure appropriate participation from people living with dementia and their carers in the ToC process.

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