Participatory assessment of the health of Latino immigrant men in a community with a growing Latino population

Effectiveness of a Promotores Network to Improve Health in an Emerging Latino Community

BACKGROUND

Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, promotor-led intervention on access to care, physical activity, dietary practices, and perceived social support among Latino adults living in an emerging community, compared with a nonrandomly assigned control group.

METHOD

Participants (n = 81 intervention; n = 86 control) were drawn from Allegheny county, Pennsylvania. Promotores used an intervention tool offering nondirective social support to assist participants in developing SMART goals to address their life concerns in eight domains (e.g., social, diet, and exercise/recreation); the control group received printed materials. Participants completed a survey in Spanish at baseline and follow-up to assess outcomes and had their height and weight measured. Adjusted linear mixed effects models compared change in outcomes over time.

RESULTS

There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group.

CONCLUSION

This study demonstrates the potential effectiveness of a promotores network in assisting individuals living in an emerging Latino community to address their life concerns and improve health behaviors. Future studies should include objective and more rigorous measures with a larger sample to replicate these results.

Community health workers promote perceived social support among Latino men: Respaldo

Promotores or community health workers are trusted community members who offer information and support to marginalized groups in society. Latinx immigrants in new growth communities or emerging communities (areas with a small yet growing Latinx population) confront many challenges in their settling processes. De la Mano con la Salud was a community-based participatory project that trained Latino immigrant men as promotores. Promotores recruited 182 Latino immigrant men helped them to attain their own goals, connected them with health and social services and connected them to the larger community. We present data from 23 in-depth interviews with project participants conducted after six months of enrollment. Qualitative analysis confirmed participants’ vulnerabilities and showed that promotores addressed many of the health, legal, and occupational needs of participants. Emerging themes showed that 1) participants had a thirst for a united Latinx community; and 2) felt that promotores had their back (respaldo). The need for community may reflect the current invisibility of this Latinx population, as well as the desires for recognition and ethnic identity affirmation. Respaldo strongly resembles perceived social support, which is the kind of support most associated with health outcomes. Future research can determine what intervention components best foster respaldo.

Engaging Latinos in an Academic-Community Partnership in Montana through a Health Screening Event

Background

Engaging minorities in research especially in Montana where Latinos make up a small percentage of the population can be a challenge. We describe an effort to recruit Latinos into a research study by hosting a health screening event.

Purpose

This event served as the first step in the creation of an academic-community partnership.

Methods

We formed an interdisciplinary research team and involved key community stakeholders in planning a health screening event. We provided lunch, flu vaccinations, and screening measures including blood pressure, body mass index, and diabetes status. We also asked for volunteers to sign up to participate in future focus groups.

Results

Thirty five people participated in the health screening event, and 29 people volunteered to engage in future research. The majority of participants reported not having health insurance or a regular medical provider, were overweight or obese, and did not have diabetes.

Discussion

Engaging the Latino community in research is important, and this paper describes the first step in the creation of an academic-community partnership.

Translation to Health Education Practice

Attention to community needs through active partnership and adherence to the responsibilities and competencies for health education specialists provides an example of a successful study that can be adapted to other populations.A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars.

Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers

BACKGROUND

Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising promotora-led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned.

METHODS

Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and promotoras in a subsample of 12 families.

RESULTS

Promotoras recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity).

CONCLUSION

Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.

"The solitude absorbs and it oppresses": 'Illegality' and its implications on Latino immigrant day laborers' social isolation, loneliness and health

Despite a well-documented relationship between social isolation and health among men, this link has been understudied among marginalized populations such as undocumented immigrant men whose structural social exclusion may impede the cultivation and maintenance of social connections in the United States. This may be particularly so in new immigrant settlement cities that may lack an established Latina/o community or the social infrastructure often needed to ease the process of social integration. Studies that have examined social disconnectedness, social isolation, and/or loneliness have largely focused on individual level factors (i.e., older age) that may precipitate or contextualize experiences of social isolation, social support and social networks. Missing from such conceptualizations is a consideration of the role of structural factors, such as "illegality" among undocumented immigrant men, on experiences of social disconnection, social exclusion, social isolation and loneliness and resultant adverse health behaviors. This study, through in-depth qualitative participant narratives, explores the social condition of one group of "illegal" immigrant men, Latino immigrant day laborers (LIDL), and their experiences of social exclusion, social isolation, loneliness and health in the new immigrant settlement city of Baltimore. Using an ethnographic methodological approach, eight focus groups (N = 37) were conducted with participants recruited from two day labor sites from 2016 to 2019. Thematic analysis revealed a structural process of social exclusion and disconnection that exposed LIDLs to experiences of racism, structural vulnerability, and dehumanization which in turn may have heightened social isolation and loneliness and patterned substance use and sexual risk taking. Findings further emphasize the potential conceptual significance of structurally induced social disconnection, as distinct from lack of social support, in the study of LIDLs' social isolation, loneliness and health.

Nocturnal awakenings of Brazilian immigrants in Massachusetts

OBJECTIVE

The purpose of this study was to assess the relationship between the quantity of jobs and nocturnal awakenings of Brazilians living in Massachusetts.

MATERIAL AND METHODS

We sampled of 48 documented Brazilians around the age of 45.5 years old. 52.1% of them were women. Data gathering occurred for three weeks, using the Pittsburgh Sleep Quality Index. Participants also wore wrist actigraph and filled sleep/wake diary for a week.

RESULTS

The sleep quality of immigrants with one job (mean=8.58, SD=4.16) is better when compared to immigrants with 2-3 jobs (mean=12.7, SD=3.57) according to the PSQI scores. Immigrants with 2-3 jobs reported dissatisfaction on three components of the scale: sleep duration, sleep efficiency and sleep quality.

DISCUSSION

There is a positive relationship between the quantity of jobs and nocturnal awakenings and between nocturnal awakenings and complaints related to sleep apnea among Brazilians in Massachusetts. The assessment of systemic morbidities associated with sleep pattern changes should be considered in future research.

Bilingual and Bicultural Research Teams: Unpacking the Complexities

Researchers often describe use of “bilingual/bicultural” research teams, especially for research being conducted with marginalized communities. In this perspectives article, we argue that while increasing the diversity of research teams is imperative, using the term “bilingual/bicultural” without further explanation is problematic. We first review the nuances of the terms bilingual and bicultural individually. Next, we describe how the terms bilingual and bicultural cannot be conflated. Finally, we provide recommendations for researchers, journals, and funding agencies.

Outcomes from a Male-to-Male Promotores Intervention in an Emerging Latino Community

Emerging Latino communities experience social isolation and lack services tailored to their culture. Few male-to-male promotores (community health workers in Spanish) interventions exist. This 6-month participatory study aimed to improve social support, healthcare access, depressive symptoms, and decrease alcohol consumption among Latino immigrant men. Promotores delivered non-directive social support to participants recruited from community venues. We analyzed baseline and 6-month questionnaires data (n = 89) using paired chi square tests. All participants were immigrants; 47% had not finished high school, 29% had depression symptoms, 35% reported past month binge drinking and 93% were uninsured. The intervention significantly improved having a usual source of care (24 to 43%), doctor's visits (41 to 62%) and dentist's visits (27 to 42%) in the past year. Other outcomes did not improve. Male promotores increased healthcare access among vulnerable Latino men. Addressing drinking behavior and depression may require longer interventions or specialized providers.

Latino Parents' Perceptions of Physical Activity and Healthy Eating: At the Intersection of Culture, Family, and Health

OBJECTIVE

To explore Latino parents' perspectives on healthy living and identify strategies to incorporate in a future child obesity intervention.

DESIGN

Descriptive, qualitative study.

SETTING

Participants were recruited from an emerging Latino community (area with low [ < 5%] yet growing concentrations of Latinos) in Allegheny County, PA.

PARTICIPANTS

Thirty-two parents of preschool children participated in 5 Spanish-language focus groups.

PHENOMENON OF INTEREST

Parents' perceptions of a healthy lifestyle (ie, physical activity and nutrition).

ANALYSIS

Data were analyzed using the constant comparison method to identify salient categories, themes, and patterns.

RESULTS

Three overarching themes were identified: (1) Healthy Living: Beyond One's Control; (2) Estamos Acostumbrados [We Are Used to a Certain Lifestyle]; and (3) Latin American and US Culture Conflict. In general, parents perceived maintaining a healthy lifestyle to require enormous effort and that change was difficult given a lack of knowledge and control.

CONCLUSIONS AND IMPLICATIONS

Key intervention approaches with this population may include a focus on the family environment. Increasing knowledge, building self-efficacy, and modeling behavior through family recipe preparation and physical activity breaks may be necessary, as well as an emphasis on and orientation to community resources to support behavior change and physical activity and healthy eating habits.

ANDALE Pittsburgh: results of a promotora-led, home-based intervention to promote a healthy weight in Latino preschool children

Background

Latino preschool children have higher rates of obesity than preschool children from other racial/ethnic groups; however, few effective, culturally appropriate interventions exist targeting this group. The purpose of this study was to test the feasibility of a 10-week, promotora-mediated, home-based intervention to promote a healthy weight in Latino preschool children.

Methods

Trained promotoras (community health workers) delivered 10, 90-min weekly interactive and tailored sessions to Latino families living in Allegheny County. Participants were recruited through promotoras’ own social networks and community gatherings, flyers, and word of mouth. Primary outcome measures included child body mass index (BMI) z-score and percentile. Secondary outcome measures included child objectively measured physical activity and dietary intake, and the home social and physical environment (e.g., parent health behaviors, parent self-efficacy, parental support, physical activity equipment in the home). The final analysis sample included 49 of 51 participants who completed both baseline and follow-up assessments.

Results

Participants included mothers (33.5 ± 6.1 years old) and their preschool-aged children who were primarily 1st generation immigrants from Mexico (65%). The primary analyses of BMI percentile and z-score showed no change post-intervention. However, there was a significant decrease in child BMI percentile for overweight and obese children from baseline to follow-up (p < .05). We also saw significant pre/post increases in child daily fruit and vegetable intake, and parent moderate-to-vigorous physical activity, fruit and vegetable servings per day, and self-efficacy; and significant decreases in child saturated fat and added-sugar intake, and child and parent screen time (p’s < .05).

Conclusions

Despite the short duration of the intervention and follow-up, this pilot study showed promising effects of a promotora-mediated intervention to promote a healthy weight in Latino preschool children.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5266-3) contains supplementary material, which is available to authorized users.

Social Support, Health, and Health Care Access Among Latino Immigrant Men in an Emerging Community

Objective. To determine the association of social support with alcohol abuse, depression, and health care access among Latino immigrant men in an emerging Latino community (an area with a small yet growing Latino population). Methods. Cross-sectional baseline data of 140 men prior to a participatory male-to-male community health worker intervention among Latino immigrants were analyzed using logistic regression. Community health workers recruited community participants in Western Pennsylvania between 2011 and 2013. Results. Participants constituted a vulnerable group: 47% had not finished high school, 36% had moderate to severe depression, and 30% reported binge drinking in the past month. Health care access was low (insurance = 6%, usual source = 20%). In multivariable logistic regression high social support was associated with less binge drinking (odds ratio [OR] = 0.44; 95% confidence interval [CI] [0.20, 0.98]) and lower depression (OR = 0.22; 95% CI [0.09-0.54]). Social support was associated with having a dentist visit but not with other health care access measures. Conclusions. Results indicate that the role of social support seems important for drinking and depression but remains controversial for health care access. It raises the hypothesis that low social support may be one of the mechanisms for the increase in drinking that happens after immigration.

Responding to health and social needs of aging Latinos in new-growth communities: a qualitative study

BACKGROUND

The development of new-growth communities of Latino immigrants in southern states has challenged the traditional health and social service infrastructure. An interprofessional team of service providers, Latino leaders, and university faculty partnered to establish linkages with the Latino community and providers serving aging adults and to explore the health and social needs of aging Latinos residing in a rural region.

METHODS

A qualitative descriptive study was conducted through a community-university partnership, the Aging Latino Research Team (ALRT). Data were generated from nine focus groups and 15 key informant interviews with Latino and non-Latino community members and service providers in rural, eastern North Carolina (ENC).

RESULTS

Thematic analysis was used to identify common patterns and form recommendations for future research and programs. Themes common to Latino participants were: "We are put off to one side"; "If I can't work, I can't survive"; and "Without documents, you are no one." Themes common to non-Latino participants were: "Older Latinos are not well served"; "Older Latinos are invisible"; "Older Latinos are undocumented and afraid"; and "Older Latinos are wandering the highway".

CONCLUSION

A major finding of this research was the extent to which discrepancies in perceptions between Latino participants and non-Latino participants exist. These discrepancies revealed ethnic stereotyping and cultural insensitivity as major barriers in access to care.

Helping undocumented children in an emerging Latino community

Purpose

The purpose of this paper is to describe and discuss the limitations of strategies that mothers of undocumented Latino children use in an emerging community to address the health needs of their children.

Design/methodology/approach

In-depth interviews with low-income immigrant mothers of undocumented Latino children (n=10) and social service providers (n=6). Interviews were transcribed, coded using Atlas-ti and analyzed to identify common perspectives on the strategies used to secure healthcare for uninsured undocumented children.

Findings

Mothers of undocumented Latino children struggle to secure healthcare for their children. Based on the principles of familismo and personalismo, they rely on social support networks such as friends, relatives and fellow churchgoers to secure information about available healthcare options. Despite the willingness of social and health service providers to help them access healthcare, options are limited and depend on the actions of individuals rather than organized solutions. Securing care for undocumented children using families, friends and sympathetic individual providers as the source of information and advice leads to fragile unsustainable solutions.

Research limitations/implications

This paper adds to the small yet growing literature of Latinos in emerging communities.

Practical implications

Emerging Latino communities are usually unprepared to welcome Latinos and address its various needs. Undocumented children are a particularly vulnerable group and any sustainable strategy to address their needs would require structural changes in existing health services to ensure that undocumented children’s lives are not affected by poor health.

Originality/value

Healthcare access problems for immigrant children are presented from the perspective of parents and offers a nuanced description of health systems unpreparedness to provide care for vulnerable groups whose immigrant status is poorly understood.

Study Protocol for a Home-based Obesity Prevention Program in Latino Preschool Children

PURPOSE

This paper describes the study design for ANDALE Pittsburgh, a culturally-appropriate, family-based intervention to promote a healthy weight in Latino preschool children.

METHODS/DESIGN

The study was organized into two major phases: Phase I: Conduct focus groups with 30 Latino parents of preschool children to inform the development of a culturally-appropriate intervention; Phase II: Test the feasibility and effectiveness of the intervention with 50 families. Participants were recruited from an emerging Latino community through community gatherings, flyers, and word of mouth. Six promotoras (females >18 years, active in community) received 25 hours of training using the intervention curriculum finalized after Phase I. Promotoras delivered the home-based intervention to families over 10, 90-minute weekly sessions that included education, practice, and action (i.e., goal setting). Behavior modification constructs and strategies (e.g., goal setting, problem solving, social support), and building of self-efficacy through healthy recipe preparation and physical activity breaks, were also included. Outcomes (e.g., child BMI) were assessed pre- and post-intervention. Process evaluation assessed fidelity, dose, reach, recruitment, and contextual factors using multiple data sources and mixed methods.

DISCUSSION

The ANDALE Pittsburgh study will expand the body of knowledge on interventions to promote a healthy weight in Latino preschool children living in an emerging Latino community. If successful, this approach will be evaluated in a future, larger-scale intervention and provide a potential model to help to address and prevent obesity in this population.

Birth Experiences of Immigrant Latina Women in a New Growth Community

A woman's birth experience can impact the physical and mental well-being of mothers long after the birth of their child. Little is known about the experiences of Latina women in areas with small, yet growing Latino populations. To understand Latina's perceptions of their childbirth experience and to see how insurance status impacts that experience, we conducted in-depth, semi-structured interviews with a non-proportional quota sampling of ten Latina women, five with and five without health insurance. Most women reported a positive global experience; the birth of a healthy child was the most important factor influencing birth experiences for all of them. Locus of control and support from medical providers and loved ones also shaped experiences. Uninsured women reported lower levels of perceived control and support, which did impact their birthing experience. These differences could be influenced by social status and position. Medical provider, hospital, and policy recommendations are made which could lead to improvements in uninsured Latinas' childbirth experiences.

Promotores' perspectives on a male-to-male peer network

Little documentation exists about male community health workers (promotores) networks. The experiences of promotores can provide input on how to attract, train, supervise and maintain male promotores in CHW programs. We present the experience and perspectives of promotores who participated in a male promotores network assisting Latino immigrant men in an emerging Latino community. All promotores in this community-based participatory study received payment for work 10 hours a week. We conducted qualitative interviews with all promotores starting the program, after 5 and 13 months. Three main themes emerged: 1) Men decided to become promotores to help others, yet appreciated being paid. 2) Promotores' learning experience was ongoing and was facilitated by a cooperative dynamic among them. Learning how to listen was crucial for promotores 3) Promotores experienced difficulty separating their personal lives form their role as a promotor We conclude that paying promotores facilitates the fulfillment of their drive to serve the community. Enhancing listening abilities needs to be part of promotores' training curricula. Finally, it is advisable to build a project with many opportunities for promotores and project staff to share professional and non-professional time and discuss their challenges.

A Male Promotores Network for Latinos: Process Evaluation From a Community-Based Participatory Project

Background Lay health advisor (LHA) interventions with Latino men are rare, especially in emerging Latino communities. We present a process evaluation of a male LHA network aiming at connecting Latino men to various kinds of services and to the Latino community. It assesses the feasibility of (1) maintaining a steering coalition; (2) hiring, training, and retaining male LHA; and (3) recruiting and assisting underserved participants. Methods Project management data and LHA debriefings were analyzed qualitatively and compared to a logic model and evaluation table prepared before the project started. Results The community coalition steered the project during its implementation. Eleven men attended the initial LHA training. Two thirds of them reflected the community in educational level. One third did not and required extra mentoring from the other LHA to recruit participants. LHA requested topics for monthly trainings according to their needs in the field, including housing, sexual health, and immigration. LHA enrolled 182 participants. Participants' needs went beyond health issues. Therefore, LHA needed to forge new collaborations with local social service organizations. Conclusions Recruiting male LHA is feasible. LHA and the community coalition can suggest adaptations to fit the local context.