Dietary beliefs and behaviour of a UK Somali population

Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

Household Water Is the Main Source of Iodine Consumption among Women in Hargeisa, Somaliland: A Cross-Sectional Study

BACKGROUND

Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 μg/L) in groundwater used for drinking and cooking, but the relation with iodine intake is not well characterized.

OBJECTIVES

We aimed to investigate the contributions of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration (UIC) and excretion (UIE) over a 24-h period and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38 L/d (hydration adjusted).

METHODS

The study sample comprised 118 nonpregnant, healthy women aged 15-69 y. All participants resided in Hargeisa, and 27 were breastfeeding. Data collection consisted of a 24-h urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household water samples using the Sandell-Kolthoff reaction.

RESULTS

WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P < 0.003). Nonbreastfeeding women were borderline iodine sufficient [hydration-adjusted median urinary iodine concentration (mUIC) 109 μg/L; 95% CI: 97, 121 μg/L], whereas breastfeeding women showed a mild iodine deficiency (73 μg/L; 95% CI: 54, 90 μg/L). There were strong correlations (ρ: 0.50-0.69, P = 0.001) between WIC and UIC, with iodine from household water contributing more than one-half of the total iodine intake. Multivariate regression showed hydration and breastfeeding status to be the main predictors of UIC.

CONCLUSIONS

Iodine from household water is the main contributor to total iodine intake among women in Hargeisa, Somaliland. Variation in female hydration and spatial and temporal WIC may explain diverging mUIC between studies. Water sources at the extremes of low and high iodine concentrations increase the risk of subpopulations with insufficient or more than adequate iodine intake.

Psychosocial Correlates of Experience and Intention to Receive Colorectal Cancer Screening: A Cross-Sectional Study Among East African Men in the U.S

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

A qualitative study of barriers and enablers associated with colorectal cancer screening among Somali men in Minnesota

The rate of cancer screening is generally increasing in the US. In Minnesota, the statewide average rate of screening for colorectal cancer (CRC) is 73%. However, screening completion is relatively low among Somali men; overall, only 27% of Somali immigrants have been screened for CRC. Factors contributing to this disparity have not been well researched. The purpose of this pilot study was to employ focus group methodology to describe and advance understanding of the barriers and enablers associated with CRC screening among Somali men ages 50-74 in Minnesota. Three focus groups were conducted among 27 Somali men in Minnesota. A 9-question, semi-structured interview guide was used. The sessions were audio recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Three research team members utilized the constant comparative method and NVivo to conduct data analysis. Five barriers to CRC screening emerged from the analyses: (1) lack of knowledge, (2) emotional barriers, (3) acculturation, (4) accountability, and (5) fatalistic beliefs. In addition, two factors enabling CRC screening and prevention emerged: the need for tailored interventions and preventive lifestyle behaviors. The insights gained from this research will assist in developing health promotion and education-focused interventions that encourage Somali immigrants in Minnesota and beyond to seek early detection screening for CRC.Abbreviations: CRC: Colorectal Cancer; FIT: Fecal Immunochemical Test; FOBT: Fecal Occult Blood Test; FQHC: Federally Qualified Health Center; PA: Project Assistant; PI: Principal Investigator.

When richer doesn't mean thinner: Ethnicity, socioeconomic position, and the risk of child obesity in the United Kingdom

BACKGROUND

A range of studies report a robust association between family socioeconomic position and the prevalence of child overweight/obesity. On average, children from poorer backgrounds are more likely to be overweight/obese than children from more advantaged families. However, a small number of US studies have shown that, for ethnic minority children, the association is either nonexistent or reversed.

OBJECTIVE

We test if the link between socioeconomic position and child overweight/obesity at age 7 is heterogeneous in the United Kingdom where rates of obesity are particularly high for some groups of ethnic minority children.

METHODS

We use nationally representative data from the UK Millennium Cohort Study as well as descriptive analyses and logistic regression models.

RESULTS

Poorer White children are at higher risk of overweight/obesity than higher income White children. However, socioeconomic disparities are reversed for Black African/Caribbean children and nonexistent for children of Indian and Pakistani/Bangladeshi origin. Moreover, the health behaviours that explain socioeconomic disparities in child overweight/obesity for the White group appear to be irrelevant in explaining differences by socioeconomic position for the Black Caribbean and African groups.

CONCLUSIONS

We should be careful in assuming that higher socioeconomic position is protective against child overweight/obesity for all groups of the population.

CONTRIBUTION

This study shows for the first time important variation by ethnicity in the link between socioeconomic position and child overweight/obesity - and in the underlying mechanisms linking them - in the United Kingdom.

Somali, Latino and Hmong parents' perceptions and approaches about raising healthy-weight children: a community-based participatory research study

OBJECTIVE

Immigrants in the USA are confronted with health disparities, including childhood obesity and obesity-related chronic diseases. We aimed to identify perceptions of childhood body weight, approaches to raising healthy children and desires for supportive programmes of Somali, Latino and Hmong (SLM) parents in the Twin Cities, Minnesota, USA.

DESIGN

Using community-based participatory research, ten focus groups (FG) were conducted with sixty-seven parents (n 28 Somali, three FG; n 19 Latino, four FG; n 20 Hmong, three FG) of 3-12-year-old children in their native language. Demographic information was collected.

RESULTS

SLM parents perceived that health is not necessarily weight-based; childhood obesity is caused by overeating, eating unhealthy foods and sedentary activities; traditional foods are generally healthy while American foods are generally unhealthy; and healthy children are inherently physically active. Parents identified their goals as feeding children so they would be healthy and happy, helping them be active and safe, and teaching them to cook traditional foods to be self-sufficient and maintain their cultural identity. Parents were challenged by children's unhealthy food and sedentary preferences, their own uncertainties about healthy foods and behaviours, and structural factors. Parents thought interventions could help them with these challenges, including information about healthy foods, age-appropriate portion sizes, safe places to be active and strategies tailored to their cultural norms.

CONCLUSIONS

SLM parents are trying to raise healthy-weight children based on their understanding of children's health, weight, diet and physical activity, while dealing with social, economic and environmental challenges and trying to maintain cultural identity and traditions.

Prevalence and Predictors of Overweight and Obesity among Somalis in Norway and Somaliland: A Comparative Study

BACKGROUND AND AIM

The knowledge about the health status of Somalis in Norway and Somaliland is limited. This paper reports the results of a comparative study on the prevalence and predictors of overweight/obesity among Somalis in Norway and Somaliland.

METHOD

We conducted two cross-sectional studies using the same tools and procedures, between 2015 and 2016. The study population was adults aged 20-69 years (n=1110 (Somaliland) and n=220 (Norway)).

RESULTS

The prevalence of obesity (body mass index (BMI) ≥30 kg/m²) was 44% and 31% in women in Norway and Somaliland, respectively. In contrast, the prevalence of obesity was low in men (9% in Norway; 6% in Somaliland). Although the prevalence of high BMI was higher in Somali women in Norway than women in Somaliland, both groups had the same prevalence of central obesity (waist circumference (WC) ≥ 88 cm). In men, the prevalence of central obesity (WC ≥ 102 cm) was lower in Somaliland than in Norway. For women in Somaliland, high BMI was associated with lower educational level and being married.

CONCLUSION

The prevalence of overweight and obesity is high among Somali immigrants in Norway, but also among women in Somaliland. The high prevalence of overweight and obesity, particularly among women, calls for long-term prevention strategies.

Consumption of healthy foods and associated socio-demographic factors among Russian, Somali and Kurdish immigrants in Finland

Aims: We evaluated the consumption of healthy foods among Russian, Somali and Kurdish immigrants in Finland, and examined the relationship between socio-demographic factors and food consumption. Methods: We used data from the Migrant Health and Wellbeing Study (Maamu), a population-based health interview and examination survey in six different municipalities in Finland between 2010 and 2012. Altogether, 635 men and 737 women, aged 18–64 years, of Russian ( n = 527), Somali ( n = 337) and Kurdish ( n = 508) origin were included. The important socio-demographic determinants of healthy food consumption – sex, age, education, place of residence and household size – were assessed by logistic regression. Results: Based on the consumption frequencies of recommended healthy foods – fruits, berries, vegetables, fish and rye bread – immigrants of Russian origin had higher consumption of healthy foods than their peers of Kurdish and Somali origin. Low consumption of fresh vegetables, fruits and berries was found among Somali immigrants. Sex and age were the most important determinants of healthy food consumption, as women and older age groups had diets closer to the national nutrition recommendations. High educational level was also positively associated with healthy food consumption. Conclusions: We found ethnic differences in the consumption of healthy foods among the immigrant groups of Russian, Somali and Kurdish origin in Finland. Socio-demographic factors, especially age, sex and education, seem to also play an important role in immigrants’ food consumption. Further studies examining the consumption of fruits, berries and fresh vegetables among Somali immigrants in Finland are needed.

Barriers and Facilitators to Healthy Lifestyle Changes in Minority Ethnic Populations in the UK: a Narrative Review

Minority ethnic populations experience a disproportionate burden of health inequalities compared with the rest of the population, including an increased risk of type 2 diabetes (T2DM). The purpose of this narrative review was to explore knowledge and attitudes around diabetes, physical activity and diet and identify barriers and facilitators to healthy lifestyle changes in minority ethnic populations in the UK. The narrative review focused on three key research topics in relation to barriers and facilitators to healthy lifestyle changes in minority adult ethnic populations: (i) knowledge and attitudes about diabetes risk; (ii) current behaviours and knowledge about physical activity and diet; and (iii) barriers and facilitators to living a healthier lifestyle. Nearly all of the studies that we identified reported on South Asian minority ethnic populations; we found very few studies on other minority ethnic populations. Among South Asian communities, there was generally a good understanding of diabetes and its associated risk factors. However, knowledge about the levels of physical activity required to gain health benefits was relatively poor and eating patterns varied. Barriers to healthy lifestyle changes identified included language barriers, prioritising work over physical activity to provide for the family, cultural barriers with regard to serving and eating traditional food, different perceptions of a healthy body weight and fear of racial harassment or abuse when exercising. Additional barriers for South Asian women included expectations to remain in the home, fear for personal safety, lack of same gender venues and concerns over the acceptability of wearing ‘western’ exercise clothing. Facilitators included concern that weight gain might compromise family/carer responsibilities, desire to be healthy, T2DM diagnosis and exercise classes held in ‘safe’ environments such as places of worship. Our findings suggest that South Asian communities are less likely to engage in physical activity than White populations and highlight the need for health promotion strategies to engage people in these communities. There is a gap in knowledge with regard to diabetes, physical activity, diet and barriers to healthy lifestyle changes among other ethnic minority populations in the UK; we recommend further research in this area.

The FAV-S Pilot Study

The 2012 FAV-S pilot study was developed as a dietary intervention program for low-income Somali mothers grounded in the health belief model. The intervention was geared toward increasing fruit and vegetable intake among participants’ children. The purpose of this analysis was to determine the impact of the FAV-S program on participants’ (1) self-efficacy in ability to serve more fruits and vegetables, (2) knowledge and beliefs about healthy eating, and (3) perceived barriers to accessing healthy foods. Furthermore, this study assessed change in fruit and vegetable intake among participants and their children. The intervention consisted of two small group education sessions addressing nutrition, serving size, and label reading; a cooking session incorporating fruits and vegetables into traditional Somali dishes; and a grocery store session demonstrating best purchasing practices. Self-efficacy, knowledge and beliefs, and perceived barriers were assessed via surveys administered verbally in Somali pre- and postintervention. Paired t tests were used to compare pre- and postintervention survey responses. Twenty-five women participated in the pilot study; mean age was 43.6 years ( SD = 12.4). Self-efficacy significantly increased among participants postintervention ( p = .01), though there were no significant changes in knowledge and beliefs or perceived barriers. Following intervention, daily servings of fruits and vegetables significantly increased among both women and children ( p = .01 to p < .01). Findings suggest that a multistage, culturally tailored, approach is effective at increasing self-efficacy and fruit and vegetable intake in the Somali community. Continued and expanded research is needed to further develop culturally focused dietary interventions.

Diabetes Risk by Length of Residence among Somali Women in Oslo Area

Type 2 diabetes represents a major health problem worldwide, with immigrants strongly contributing to the increase in diabetes in many countries. Norway is not immune to the process, and immigrants in the country are experiencing an increase in the prevalence of diabetes after arrival. However, the dynamics of these transitions in relation to the duration of residence in the new environment in Norway are not clearly understood. From this background, a cross-sectional quantitative study using a respondent-driven sampling method was conducted among 302 Somali women living in Oslo area. The results show that 41% of the study participants will be at risk for developing diabetes in the coming 10 years, which coincides with 85% of the study participants being abdominally obese. Significant associations were found between years of stay in Norway and the risk for diabetes with those who lived in Norway >10 years, having twofold higher odds of being at risk for developing diabetes compared to those who lived in Norway ≤5 years (OR: 2.16, CI: 1.08-4.32). Understanding the mechanisms through which exposure to the Norwegian environment leads to higher obesity and diabetes risk may aid in prevention efforts for the rapidly growing African immigrant population.

Beyond Culture and Language: Access to Diabetes Preventive Health Services among Somali Women in Norway

Despite the high prevalence of type 2 diabetes in some immigrant and refugee communities in Norway, there is very little information available on their utilization of diabetes prevention interventions, particularly for women from Somali immigrant communities. A qualitative study of 30 Somali immigrant women aged 25 years and over was carried out in the Oslo area. Unstructured interviews were used to explore women's knowledge of diabetes, their access to preventive health facilities, and factors impeding their reception of preventive health programs targeted for the prevention of type 2 diabetes. The study participants were found to have a good knowledge of diabetes. They knew that a sedentary lifestyle and unhealthy diet are among the risk factors for diabetes. Regardless of their knowledge, participants reported a sedentary lifestyle accompanied with the consumption of an unhealthy diet. This was attributed to a lack of access to tailored physical activity services and poor access to health information. Considering gender-exclusive training facilities for Somali immigrant women and others with similar needs, in addition to access to tailored health information on diet, may encourage Somali women to adopt a healthy lifestyle, and it will definitely contribute to a national strategy for the prevention of diabetes.

What are the barriers to primary prevention of type 2 diabetes in black and minority ethnic groups in the UK? A qualitative evidence synthesis

BACKGROUND

This review aimed to synthesise available qualitative evidence on barriers and facilitators to the implementation of community based lifestyle behaviour interventions to reduce the risk of diabetes in black and minority ethnic (BME) groups in the UK.

METHODS

A search of medical and social science databases was carried out and augmented by hand-searching of reference lists and contents of key journals. Qualitative evidence was synthesised thematically.

RESULTS

A total of 13 papers varying in design and of mainly good quality were included in the review. A limited number of intervention evaluations highlighted a lack of resources and communication between sites. A lack of understanding by providers of cultural and religious requirements, and issues relating to access to interventions for users was reported. Behaviour change was impeded by cultural and social norms, and resistance to change. There were variations in the way dietary change and physical activity was approached by different groups and contrasting practices between generations.

CONCLUSIONS

Qualitative data provided insight into the ways that providers might improve or better design future interventions. Acknowledgement of the way that different groups approach lifestyle behaviours may assist acceptability of interventions.