Socially Isolated Cambodians in the US: Recommendations for Health Promotion

Cambodian genocide survivors experience health disparities associated with their traumatic experiences. Cambodian community organizations in the United States are severely challenged to serve these survivors. Community leaders have identified a sub-set of community members of particular concern: those at either end of the age spectrum (elders and young people) who are socially isolated. As part of a larger community-based participatory research project, we conducted a focus group with seven Cambodian community leaders from six cities that sought to better understand the phenomenon of social isolation of Cambodian elders and young people in order to inform health promotion efforts. Cambodian leaders expressed keen concern for those community members who rarely seem to leave their homes or interact with the Cambodian community. Prominent themes identified by leaders related to isolation were: a generational pattern; benefits of extended family; health concerns; the impact of stigma and fear; lack of sufficient resources; and cultural influences. In addition, leaders identified several possible solutions to address the phenomenon of social isolation in their communities. Health promotion efforts in this population should identify isolated individuals and enhance their social connectedness and support networks as part of a larger integrated effort

Socially Isolated Cambodians in the US

Community organizations in the United States are severely challenged to serve Cambodian refugees who experience health disparities associated with their traumatic experiences. Community leaders have identified a sub-set of community members of particular concern: those at either end of the age spectrum (elders and young people) who are socially isolated. As part of a larger community-based participatory research project, we conducted a focus group with seven Cambodian community leaders from six cities. The study sought to better understand the phenomenon of social isolation of Cambodian elders and young people in order to inform health promotion efforts. Cambodian leaders expressed keen concern for those community members who rarely seem to leave their homes or interact with the Cambodian community. Prominent themes identified by leaders related to isolation were: a generational pattern; benefits of extended family; health concerns; cultural influences and language; impact of stigma; fear and safety concerns; and lack of sufficient resources. In addition, leaders identified several possible solutions to address the phenomenon of social isolation in their communities. Health promotion efforts with this population should identify isolated individuals and enhance their social connectedness and support networks as part of a larger integrated effort

Nutrition Knowledge Is Related to Food Security, Literacy, and Nutrition Education in Cambodian Refugee and Asylee Women in Lowell, Massachusetts

Refugees experience elevated risk of chronic disease post-resettlement. Understanding contributors to refugee knowledge of the connection between food and health may help promote healthful resettlement. A random survey was conducted with Cambodian refugee and asylee women in Lowell, MA (n = 160). Knowledge of the connection between health and food categories (meat with fat, soda, fast food, high-sodium sauces, salt, vegetables, fruit, and whole grains) was assessed. High food security, literacy, and having participated in nutrition education were related to higher knowledge. Approaches to refugee health should include improving food security and should be tailored to varied literacy levels.</p

Community-based diabetes prevention randomized controlled trial in refugees with depression: effects on metabolic outcomes and depression

Abstract Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either (a) antidepressant medication and/or (b) prolonged elevated depressive symptoms. Participants were randomized to one of three community health worker (CHW) interventions: (1) lifestyle intervention called Eat, Walk, Sleep (EWS), (2) EWS plus medication therapy management sessions with a pharmacist/CHW team to resolve drug therapy problems (EWS + MTM), or, (3) social services (SS; control). Assessments were at baseline, post-treatment (12 months), and follow-up (15 months). The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal educational attainment was 7.0 years. Compared to the other arms, EWS + MTM showed a significant decrease in HbA1c and a trend for reduced inflammation and stress hormones. Depressive symptoms improved for EWS and EWS + MTM relative to SS. There was no change in insulin resistance. Cardiometabolic and mental health can be improved in tandem among immigrant and refugee groups

Lay health worker research personnel for home-based data collection in clinical and translational research: Qualitative and quantitative findings from two trials in hard-to-reach populations

Abstract Aims: The role of lay health workers in data collection for clinical and translational research studies is not well described. We explored lay health workers as data collectors in clinical and translational research studies. We also present several methods for examining their work, i.e., qualitative interviews, fidelity checklists, and rates of unusable/missing data. Methods: We conducted 2 randomized, controlled trials that employed lay health research personnel (LHR) who were employed by community-based organizations. In one study, n = 3 Latina LHRs worked with n = 107 Latino diabetic participants. In another study, n = 6 LHR worked with n = 188 Cambodian American refugees with depression. We investigated proficiency in biological, behavioral, and psychosocial home-based data collection conducted by LHR. We also conducted in-depth interviews with lay LHR to explore their experience in this research role. Finally, we described the training, supervision, and collaboration for LHR to be successful in their research role. Results: Independent observers reported a very high degree of fidelity to technical data collection protocols (>95%) and low rates of missing/unusable data (1.5%–11%). Qualitative results show that trust, training, communication, and supervision are key and that LHR report feeling empowered by their role. LHR training included various content areas over several weeks with special attention to LHR and participant safety. Training and supervision from both the academic researchers and the staff at the community-based organizations were necessary and had to be well-coordinated. Conclusions: Carefully selected, trained, and supervised LHRs can collect sophisticated data for community-based clinical and translational research

Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep

Abstract Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. Methods Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). Results The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen’s d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. Conclusions CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering Trial registration ClinicalTrials.gov identifier NCT02502929