Lohr, Abby M.

Introduction: Health promotion programs focused on cardiovascular disease are underutilized with im/migrants. The one-time referral to group-based interventions model ignores (1) the complex sociocultural influences on behavior change and (2) the socio-historical context of migration, racialization of immigrants and refugees, and the roles these play in differential social integration of refugees. One solution may be to apply community-based participatory research (CBPR) and Public Health Critical Race Praxis (PHCRP) to social network interventions with opinion leaders. Yet, these interventions are challenging to scale. There is a critical need to understand how to scale community-driven social network interventions to effectively address cardiovascular disease inequities resulting from systemic racism experienced by im/migrant populations. Developed using CBPR and informed by PHCRP, this work builds upon Healthy Immigrant Community (HIC), a collaborative effort between Latinx and Somali im/migrant partners and Rochester Healthy Community Partnership. Our aim is to explore opinion leader recruitment, their characteristics, and expectations for HIC scale-up. Qualitative Hypothesis: Learning more about the opinion leaders’ background and experience in the Healthy Immigrant Community social network intervention will prepare us for a future efficacy study. Methods: We conducted a process evaluation by: (1) interviewing community partners who recruited opinion leaders (n=8) and (2) conducting three pre-intervention focus groups with opinion leaders (Latinx n=4; Somali women n=8; Somali men n=8). We used PHCRP to deductively form codes yet allowed for new ideas that arose from the data by inductively generating additional codes. Results: Interview participants described their decision-making process, qualities considered, recruitment strategies, and expectations for an implementation study. Focus group participants discussed their personal motivations for participation, how they hoped the study would help their community, and the barriers to health they experience because of structural determinism (macro-level forces that sustain inequities). Conclusions: This work will enhance our ability to translate HIC to other communities by expanding our knowledge of opinion leader characteristics that are important in a community-driven, social network intervention. Because social network interventions have been demonstrated to cause positive behavior change, further adapting these interventions in a community setting would be expected to provide a more effective approach compared to individually targeted behavior change strategies. Additionally, selecting OLs is neither time nor resource intensive and could enhance organizational strategies for implementing health promotion programming.

The purpose of our evaluation is to provide an example of how public health schools can use service-learning courses to teach students about health equity. By ensuring that the future workforce has a comprehensive understanding of regions such as the U.S./Mexico border, students will be better equipped to provide public health services. Specifically, our objectives were to (1) understand how student perceptions of the border evolve during the 1-week Border Health Service-Learning Institute (BHSLI) course and (2) understand how the service-learning experience impacted students’ proposed personal and professional goals. Using BHSLI student journals collected over 9 years, we conducted a qualitative investigation to evaluate students’ experiences of the service-learning course. Our findings suggest that BHSLI offered opportunities for advancing dialogue about health equity. Because BHSLI is immersive, it showed students a reality that they would not normally encounter. In reflecting on these new experiences, students were not only encouraged to question systems and policies but also made accountable to act upon the insights they gained. We found that BHSLI was a space for critical consciousness building, for shifting paradigms. Students learned how to intervene in real time to make change around public health issues. Service learning could be a practice-based solution to help public health students learn about health equity, especially in historically marginalized regions such as the U.S./Mexico border.