"Was Test Designed for Africans?" Health Literacy and African Immigrants

The Tulumbe! Partnership: a case study in developing a community-led research agenda to address HIV among African immigrants in the United States

Grassroots, community organizations are trusted resources within communities, which puts them in an ideal position to effectively engage individuals impacted by health inequities in defining meaningful research priorities. A community-centered approach to HIV research is critical for African immigrants living in the United States, who experience stigma and other socio-structural barriers to HIV prevention, care, and research engagement. Supporting community organizations with financial resources and capacity building activities to lead the development of research agendas ensures better alignment with community interests and fosters sustainability. We developed a community-initiated and -led research engagement project-Tulumbe!, which prioritized community leadership in all project activities. Community forums, health care provider and community questionnaires, interviews, and report-back sessions were held to examine the research interests and health concerns voiced by African immigrants. The iterative, community-led engagement process of more than 200 African immigrants, health providers, and researchers resulted in a community-defined research agenda with six areas of focus: family communication; self-efficacy for African immigrant women; deconstructing masculinity for African immigrant men; sexual health education for African immigrant youth; HIV stigma; and health literacy. Time, resources, and flexibility are needed to develop a viable community-led research partnership. Investing in community leadership not only produced a patient-centered research agenda but also led to community ownership of the process and results; thus, all partners were committed to sustaining the work.

Exploring the dietary practices and perceptions of African immigrants in Illinois- a qualitative study of immigrants from Nigeria and Congo

OBJECTIVE

Previous studies suggest an increased prevalence of diet-related chronic diseases among African immigrants with increased length of stay in the U.S. The objective of the current study is to understand the dietary practices and perceptions of recent African immigrant families.

DESIGN

Focus group sessions were conducted with Nigerian and Congolese immigrant parents residing in Illinois. Participants were recruited using convenience sampling methods and focus group sessions were conducted via videoconference. Participants discussed dietary practices, meal preparation, and family mealtimes for their families. They also discussed experiences with eating different kinds of foods since arrival in the U.S. Verbatim transcription of focus group sessions were completed and deductive thematic analysis of transcribed data was conducted using NVivo (QSR International Pty Ltd. [2020] NVivo [version 12]).

RESULTS

Twenty African immigrant parents (Mean age: 42 years, Female: 95%) residing in Northern and Central Illinois participated in a total of five focus group sessions. Seven themes were derived from the analysis. Participants had a positive attitude toward healthy diet and had a high level of interest in receiving educational resources to make healthier food choices. Participants preferred and mostly consumed foods they were familiar with before migration. A majority of the participants perceived 'American foods' as unhealthy, characterizing them as containing a high amount of sugar and salt. Parents reported that their school-aged children often preferred a western diet over traditional African meals.

CONCLUSION

This study helps to understand unique diet-related practices and perceptions of recent Nigerian and Congolese African immigrants in Illinois. Findings could help to inform cultural adaptation of evidence-based nutrition education programs for these groups of African immigrants.

Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program

In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy. Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers, reached 3000 community members via social media campaigns, and an additional 2320 through other person-to-person outreach events. The program was effective and resulted in the vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.

Modifiable predictors of health literacy in working-age adults - a rapid review and meta-analysis

BACKGROUND

Health literacy comprises the ability to identify, obtain, interpret and act upon health information. Low health literacy is a major risk factor for hospitalizations, use of emergency care and premature mortality among others. Known risk factors for low health literacy such as lower educational attainment, migration history and chronic illnesses overlap with those for long-term unemployment - in itself a risk factor for low health literacy. These factors are difficult to address in interventions to support health literacy. Therefore, the objective of this review is to identify potentially modifiable predictors of HL in populations potentially affected by long-term unemployment.

METHODS

A rapid review (PROSPERO registration number: 290873) was carried out in Pubmed and SCOPUS including quantitative studies on potentially modifiable predictors of health literacy in working-age populations following PRISMA guidelines for systematic reviews. Where possible, reported effect sizes were transformed into r, and random-effects meta-analyses were conducted where appropriate to pool effect sizes for the association between modifiable predictors and health literacy.

RESULTS

In total, 4765 titles and abstracts were screened, 114 articles were assessed in full-text screening, and 54 were included in the review. Forty-one effect sizes were considered for 9 different meta-analyses. Higher language proficiency, higher frequency of internet use, using the internet as a source of health information more often, being more physically active, more oral health behaviours, watching more health-related TV and a good health status were significantly associated with higher health literacy. Significant heterogeneity suggests between-study differences.

CONCLUSIONS

Improving language proficiency and/or providing information in multiple and simplified languages, together with reliable and accessible health information on the internet and in linear media are potentially promising targets to improve health literacy levels in working-age populations.

"They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It": Qualitative Insights from Harambee! 2.0

African immigrants make up a large subgroup of Black/African-Americans in the US. However, because African immigrant groups are typically categorized as "Black," little is known about their preventative healthcare needs. Differences in culture, life and healthcare experiences between African immigrant populations and US-born people may influence preventive health care uptake. Thus, policymakers and healthcare providers lack information needed to make informed decisions around preventive care for African immigrants. This formative study was conducted among the largest East African immigrant communities in King County, WA. We recruited religious leaders, community leaders, health professionals, and lay community members to participate in thirty key informant interviews and five focus group discussions (n = 72 total), to better understand preventative healthcare attitudes in these communities. Through inductive coding and thematic analysis, we identified factors that impact preventative healthcare attitudes of the Somali, Ethiopian and Eritrean immigrant communities and deter them from accessing and utilizing healthcare. Cultural beliefs and attitudes around preventative healthcare, mistrust of westernized healthcare, religious beliefs/views, intersecting identities and shared immigrant experiences all influence how participants view preventative healthcare. Our results suggest that interventions that address these factors are needed to most effectively increase uptake of preventative healthcare in African immigrant communities.