Original article| Volume 22, ISSUE 2, e225-e232, March 2012

Physical Activity and Nutrition among Immigrant and Refugee Women: A Community-Based Participatory Research Approach

Published:December 12, 2011DOI:



      Immigrant and refugee populations arrive to the U.S. healthier than the general population, but the longer they reside, the more they approximate the cardiovascular risk profiles of the country. Among women, these declines are partly mediated by less physical activity and lower dietary quality upon immigration. Given the complex forces that influence these behaviors, a community-based participatory research (CBPR) approach is appropriate. Therefore, a socioculturally responsive physical activity and nutrition program was created with and for immigrant and refugee women in Rochester, Minnesota, through a CBPR approach.


      Focus groups informed program content and revealed principles for designing the sessions. A 6-week program with two, 90-minute classes per week was conducted among 45 women (Hispanic, Somali, Cambodian, and non-immigrant African American). Average attendance was 22.5 women per class; 34 women completed the evaluation.


      Evaluation revealed high acceptability (average overall score of 4.85 out of 5 on the Physical Activity Class Satisfaction Questionnaire). After the intervention, participants were more likely to exercise regularly (p ≤ .001). They reported higher health-related quality of life (p ≤ .001) and self-efficacy for diet (p = .36) and exercise (p = .10). Likewise, there were trends for weight loss (87 vs 83.4 kg; p = .65), decreased waist circumference (99.6 vs 95.5 cm; p = .35), and lower blood pressure (125/80 vs 122/76 mm/Hg; p = .27).


      A CBPR approach to design and implement a socioculturally responsive fitness program was highly acceptable to immigrant and refugee women and demonstrated promising outcomes. Further testing of physical activity and nutrition interventions that arise organically from target communities are needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Albright C.L.
        • Pruitt L.
        • Castro C.
        • Gonzalez A.
        • Woo S.
        • King A.C.
        Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project.
        Annals of Behavioral Medicine. 2005; 30: 191-200
        • Andersen L.B.
        • Harro M.
        • Sardinha L.B.
        • Froberg K.
        • Ekelund U.
        • Brage S.
        • et al.
        Physical activity and clustered cardiovascular risk in children: A cross-sectional study (The European Youth Heart Study).
        Lancet. 2006; 368: 299-304
        • Centers for Disease Control and Prevention
        Prevalence of fruit and vegetable consumption and physical activity by race/ethnicity-United States.
        Morbidity and Mortality Weekly Report. 2005; 56: 301-304
        • Chen A.H.
        • Sallis J.F.
        • Castro C.M.
        • Lee R.E.
        • Hickmann S.A.
        • William C.
        • et al.
        A home-based behavioral intervention to promote walking in sedentary ethnic minority women: Project WALK.
        Womens Health. 1998; 4: 19-39
        • Creatore M.I.
        • Moineddin R.
        • Booth G.
        • Manuel D.H.
        • DesMeules M.
        • McDermott S.
        • et al.
        Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada.
        CMAJ. 2010; 182: 781-789
        • Crespo C.J.
        • Smit E.
        • Andersen R.E.
        • Carter-Pokras O.
        • Ainsworth B.E.
        Race/ethnicity, social class and their relation to physical inactivity during leisure time: Results from the Third National Health and Nutrition Examination Survey, 1988-1994.
        American Journal of Preventive Medicine. 2000; 18: 46-53
        • Cristancho S.
        • Garces D.M.
        • Peters K.E.
        • Mueller B.C.
        Listening to rural Hispanic immigrants in the Midwest: A community-based participatory assessment of major barriers to health care access and use.
        Quality Health Research. 2008; 18: 633-646
        • Cunningham G.
        Development of the physical activity class satisfaction questionnaire.
        Measurement in Physical Education and Exercise Science. 2007; 11: 161-176
        • Dunn J.R.
        • Dyck I.
        Social determinants of health in Canada’s immigrant population: Results from the National Population Health Survey.
        Social Science in Medicine. 2000; 51: 1573-1593
        • Evenson K.R.
        • Sarmiento O.L.
        • Tawney K.W.
        • Macon M.L.
        • Ammerman A.S.
        Personal, social, and environmental correlates of physical activity in North Carolina Latina immigrants.
        American Journal of Preventive Medicine. 2003; 25: 77-85
        • Eyler A.A.
        • Brownson R.C.
        • Donatelle R.J.
        • King A.C.
        • Brown D.
        • Sallis J.F.
        Physical activity social support and middle- and older-aged minority women: Results from a US survey.
        Social Science in Medicine. 1999; 49: 781-789
        • Eyler A.A.
        • Brownson R.C.
        • King A.C.
        • Brown D.
        • Donatelle R.J.
        • Heath G.
        Physical activity and women in the United States: An overview of health benefits, prevalence, and intervention opportunities.
        Women & Health. 1997; 26: 27-49
        • Fielding J.
        • Kumanyika S.
        Recommendations for the concepts and form of Healthy People 2020.
        American Journal of Preventive Medicine. 2009; 37: 255-257
        • Gadd M.
        • Sundquist J.
        • Johansson S.-E.
        • Wändell P.
        Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?.
        European Journal of Cardiovascular Prevention & Rehabilitation. 2005; 12: 535-541
        • Gilbert P.A.
        • Khokhar S.
        Changing dietary habits of ethnic groups in Europe and implications for health.
        Nutrition Reviews. 2008; 66: 203-215
        • Goel M.S.
        • McCarthy E.P.
        • Phillips R.S.
        • Wee C.C.
        Obesity among US immigrant subgroups by duration of residence.
        JAMA. 2004; 292: 2860-2867
        • Gregg J.
        • Centurion L.
        • Maldonado J.
        • Aguillon R.
        • Celaya-Alston R.
        • Farquhar S.
        Interpretations of interpretations: combining community-based participatory research and interpretive inquiry to improve health.
        Progress in Community Health Partnerships. 2010; 4: 149-154
        • Guerin P.B.
        • Diiriye R.O.
        • Corrigan C.
        • Guerin B.
        Physical activity programs for refugee Somali women: Working out in a new country.
        Women & Health. 2003; 38: 83-99
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • Powell K.E.
        • Blair S.N.
        • Franklin B.A.
        • et al.
        Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Circulation. 2007; 116: 1081-1093
      1. Healthy People 2020: Framework. Retrieved January 9, 2011, from

        • Horowitz C.R.
        • Robinson M.
        • Seifer S.
        Community-based participatory research from the margin to the mainstream: Are researchers prepared?.
        Circulation. 2009; 119: 2633-2642
        • Israel B.A.
        • Schulz A.J.
        • Parker E.A.
        • Becker A.B.
        Review of community-based research: Assessing partnership approaches to improve public health.
        Annual Review of Public Health. 1998; 19: 173-202
        • Ware M.K.
        • Dewey J.E.
        • Gandek B.
        How to score and interpret single-item health status measures: A manual for users of the SF-8 Health Survey.
        QualityMetric, Lincoln, RI2001
        • Johnson C.E.
        • Ali S.A.
        • Shipp M.P.
        Building community-based participatory research partnerships with a Somali refugee community.
        American Journal of Preventive Medicine. 2009; 37: S230-S236
        • Kandula N.R.
        • Kersey M.
        • Lurie N.
        Assuring the health of immigrants: What the leading health indicators tell us.
        Annual Review of Public Health. 2004; 25: 357-376
        • Kaplan M.S.
        • Huguet N.
        • Newsom J.T.
        • McFarland B.H.
        The association between length of residence and obesity among Hispanic immigrants.
        American Journal of Preventive Medicine. 2004; 27: 323-326
        • Koya D.L.
        • Egede L.E.
        Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants.
        Journal of General Internal Medicine. 2007; 22: 841-846
        • Krieger J.
        • Allen C.
        • Cheadle A.
        • Ciske S.
        • Schier J.K.
        • Senturia K.
        • et al.
        Using community-based participatory research to address social determinants of health: Lessons learned from Seattle Partners for Healthy Communities.
        Health Education & Behavior. 2002; 29: 361-382
        • Lam T.K.
        • McPhee S.J.
        • Mock J.
        • Wong C.
        • Doan H.T.
        • Nguyen T.
        • et al.
        Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education.
        Journal of General Internal Medicine. 2003; 18: 516-524
        • Lauderdale D.S.
        • Kuohung V.
        • Chang S.L.
        • Chin M.H.
        Identifying older Chinese immigrants at high risk for osteoporosis.
        Journal of General Internal Medicine. 2003; 18: 508-515
        • Lear S.A.
        • Humphries K.H.
        • Hage-Moussa S.
        • Chockalingam A.
        • Mancini G.B.
        Immigration presents a potential increased risk for atherosclerosis.
        Atherosclerosis. 2009; 205: 584-589
        • Lee S.M.
        Physical activity among minority populations: What health promotion practitioners should know: A commentary.
        Health Promotion and Practice. 2005; 6: 447-452
        • Lichtenstein A.H.
        • Appel L.J.
        • Brands M.
        • Carnethon M.
        • Daniels S.
        • Franch H.A.
        • et al.
        Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee.
        Circulation. 2006; 114: 82-96
        • Liou D.
        • Contento I.R.
        Usefulness of psychosocial theory variables in explaining fat-related dietary behavior in Chinese Americans: Association with degree of acculturation.
        Journal of Nutrition Education. 2001; 33: 322-331
        • Lutsey P.L.
        • Diez Roux A.V.
        • Jacobs Jr., D.R.
        • Burke G.L.
        • Harman J.
        • Shea S.
        • et al.
        Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis.
        American Journal of Public Health. 2008; 98: 1963-1970
        • Malmusi D.
        • Borrell C.
        • Benach J.
        Migration-related health inequalities: Showing the complex interactions between gender, social class and place of origin.
        Social Science in Medicine. 2010; 71: 1610-1619
        • Marquez D.X.
        • McAuley E.
        Gender and acculturation influences on physical activity in Latino adults.
        Annals of Behavioral Medicine. 2006; 31: 138-144
        • Marquez D.X.
        • McAuley E.
        Social cognitive correlates of leisure time physical activity among Latinos.
        Journal of Behavioral Medicine. 2006; 29: 281-289
        • Martinez I.L.
        • Carter-Pokras O.
        Assessing health concerns and barriers in a heterogeneous Latino community.
        Journal of Health Care for the Poor and Underserved. 2006; 17: 899-909
        • Minkler M.
        Community-based research partnerships: Challenges and opportunities.
        Journal of Urban Health. 2005; 82: ii3-ii12
        • Nader P.R.
        • Sallis J.F.
        • Patterson T.L.
        • Abramson I.S.
        • Rupp J.W.
        • Senn K.L.
        • et al.
        A family approach to cardiovascular risk reduction: Results from the San Diego Family Health Project.
        Health Education Quarterly. 1989; 16: 229-244
        • Oza-Frank R.
        • Cunningham S.A.
        The weight of US residence among immigrants: A systematic review.
        Obesity Reviews. 2010; 11: 271-280
        • Passel J.S.
        • Cohn D.
        U.S. Population Projections: 2005-2050.
        Pew Research Center, Washington, DC2008
        • Renzaho A.M.
        • Mellor D.
        • Boulton K.
        • Swinburn B.
        Effectiveness of prevention programmes for obesity and chronic diseases among immigrants to developed countries: A systematic review.
        Public Health Nutrition. 2010; 13: 438-450
        • Shalowitz M.U.
        • Isacco A.
        • Barquin N.
        • Clark-Kauffman E.
        • Delger P.
        • Nelson D.
        • et al.
        Community-based participatory research: A review of the literature with strategies for community engagement.
        Journal of Developmental and Behavioral Pediatrics. 2009; 30: 350-361
        • Singh G.K.
        • Kogan M.D.
        • Yu S.M.
        Disparities in obesity and overweight prevalence among US immigrant children and adolescents by generational status.
        Journal of Community Health. 2009; 34: 271-281
        • Singh G.K.
        • Siahpush M.
        All-cause and cause-specific mortality of immigrants and native born in the United States.
        American Journal of Public Health. 2001; 91: 392-399
        • Sodergren M.
        • Hylander I.
        • Tornkvist L.
        • Sundquist J.
        • Sundquist K.
        Arranging appropriate activities immigrant women’s ideas of enabling exercise.
        Womens Health Issues. 2008; 18: 413-422
        • Steffen P.R.
        • Smith T.B.
        • Larson M.
        • Butler L.
        Acculturation to Western society as a risk factor for high blood pressure: A meta-analytic review.
        Psychosomatic Medicine. 2006; 68: 386-397
        • Sternfeld B.
        • Ainsworth B.E.
        • Quesenberry C.P.
        Physical activity patterns in a diverse population of women.
        Preventive Medicine. 1999; 28: 313-323
        • Sundquist J.
        • Hagstromer M.
        • Johansson S.E.
        • Sundquist K.
        Effect of a primary health-care-based controlled trial for cardiorespiratory fitness in refugee women.
        BMC Family Practice. 2010; 11: 55
        • Vertinsky P.
        “Run, Jane, run”: Central tensions in the current debate about enhancing women’s health through exercise.
        Women & Health. 1998; 27: 81-111
        • Vrazel J.
        • Saunders R.P.
        • Wilcox S.
        An overview and proposed framework of social-environmental influences on the physical-activity behavior of women.
        American Journal of Health Promotion. 2008; 23: 2-12
        • Wallerstein N.B.
        • Duran B.
        Using community-based participatory research to address health disparities.
        Health Promotion and Practice. 2006; 7: 312-323
        • Wells K.
        • Jones L.
        “Research” in community-partnered, participatory research.
        JAMA. 2009; 302: 320-321
      2. Wieland, M. L., Nelson, J., Palmer, T., O’Hara, C., Weis, J. A., Nigon, J. A., Sia, et al. (2011a). Evaluation of a tuberculosis video among immigrants and refugees at an adult education center: A community-based participatory research approach. Journal of Health Communication, In Press.

        • Wieland M.L.
        • Weis J.A.
        • Yawn B.P.
        • Sullivan S.M.
        • Millington K.L.
        • Smith C.M.
        • et al.
        Perceptions of tuberculosis among immigrants and refugees at an adult education center: A community-based participatory research approach.
        Journal of Immigrant and Minority Health. 2010; (EPub ahead of print, Oct 2010)
        • Wieland M.L.
        • Weis J.A.
        • Olney M.W.
        • Aleman M.
        • Sullivan S.M.
        • Millington K.L.
        • et al.
        Screening for tuberculosis at an adult education center: Results from a community-based participatory process.
        American Journal of Public Health. 2011; 101: 1264-1267
        • Wilbur J.
        • Chandler P.J.
        • Dancy B.
        • Lee H.
        Correlates of physical activity in urban Midwestern Latinas.
        American Journal of Preventive Medicine. 2003; 25: 69-76


      Mark L. Wieland, MD, MPH, is an Assistant Professor in the Division of Primary Care Internal Medicine at Mayo Clinic, Rochester. He is a primary care physician whose work focuses on community-based participatory research with immigrant and refugee populations.


      Jennifer A. Weis, RN, MS, is a registered nurse at the Mayo Clinic Center for Translational Science Activities. Her work is focused on health literacy and community-based participatory research.


      Tiffany Palmer, BA, is a research assistant at Olmsted Medical Center, Rochester. Her work is focused on fostering community–academic collaborations through community-based participatory research.


      Miriam Goodson, MS, is a community liaison for the Alliance of Chicanos, Hispanics, and Latin Americans in Rochester, Minnesota. Her work is focused on community advocacy and health equity.


      Sheena Loth, BA, is a community liaison for the Rochester Cambodian community. Her work is focused on community advocacy and health equity.


      Fatuma Omer, BS, is a community liaison for the Somali community and the Multicultural Learning Center in Rochester, Minnesota. Her work is focused on community advocacy, mentorship, and health equity.


      Adeline Abbenyi, BS, is a fitness specialist at the Rochester Area Family YMCA. Her work is focused on addressing barriers to physical activity among immigrant and refugee women.


      Karen Krucker, RN, is a registered nurse at the Mayo Clinic Center for Translational Science Activities. She is also a fitness specialist whose work in this area is focused on addressing barriers to physical activity among immigrant and refugee women.


      Kim Edens, MS, RD, is a research dietician at the Mayo Clinic Center for Translational Science Activities. Her work is focused on dietary assessment, research, and counseling. For this project, she is focused on addressing barriers to healthy nutrition among immigrant and refugee women.


      Irene G. Sia, MD, MSc, is an Assistant Professor in the Division of Infectious Diseases at Mayo Clinic, Rochester, Minnesota. She is a physician whose work focuses on community-based participatory research with immigrant and refugee populations.