To assess the experienced or perceived barriers and facilitators to health research participation for major US racial/ethnic minority populations, we conducted a systematic review of qualitative and quantitative studies from a search on PubMed and Web of Science from January 2000 to December 2011. With 44 articles included in the review, we found distinct and shared barriers and facilitators. Despite different expressions of mistrust, all groups represented in these studies were willing to participate for altruistic reasons embedded in cultural and community priorities. Greater comparative understanding of barriers and facilitators to racial/ethnic minorities' research participation can improve population-specific recruitment and retention strategies and could better inform future large-scale prospective quantitative and in-depth ethnographic studies.

A Systematic Review of Barriers and Facilitators to Minority Research Participation Among African Americans, Latinos, Asian Americans, and Pacific Islanders.

The intent of this chapter is to enhance understanding of various dietary assessment methods so that the most appropriate method for a particular need is chosen. This review focuses only on individual level food intake assessment. It is intended to serve as a resource for those who wish to assess diet in a research study using individual measurements for group level analysis. The chapter reviews major dietary assessment methods, their advantages and disadvantages, and validity; describes which dietary assessment methods are appropriate for different types of studies and populations; and discusses specific issues that relate to all methods.

Dietary Assessment Methodology

The US immigrant population is growing dramatically, making the health status of racial/ethnic minorities an increasingly important public health issue. Immigration to the United States is usually accompanied by environmental and lifestyle changes that can markedly increase chronic disease risk. In particular, adoption of US dietary patterns that tend to be high in fat and low in fruits and vegetables is of concern. The process by which immigrants adopt the dietary practices of the host country--called "dietary acculturation"--is multidimensional, dynamic, and complex; in addition, it varies considerably, depending on a variety of personal, cultural, and environmental attributes. Therefore, to intervene successfully on the negative aspects of dietary acculturation, it is important to understand the process and identify factors that predispose and enable it to occur. In this report, we give an overview of acculturation, define dietary acculturation and present a model for how it occurs, discuss measurement issues related to dietary acculturation, review the literature relating acculturation to eating patterns, and provide a case study illustrating how information on acculturation can be used to design dietary interventions in 2 markedly different immigrant groups. Finally, we give applications for nutrition researchers and dietetic practitioners. Studies investigating associations of acculturation with disease risk should identify and intervene on those steps in the acculturation process that are most strongly associated with unhealthful dietary changes. Practitioners working with immigrants should determine the degree to which dietary counseling should be focused on maintaining traditional eating habits, adopting the healthful aspects of eating in Western countries, or both.

Dietary acculturation: applications to nutrition research and dietetics.

Background Physical inactivity accounts for 9% of all deaths worldwide and is among the top 10 risk factors for global disease burden. Nearly half of people aged over 60 years are inactive. Efforts to identify which factors influence physical activity behaviour are needed. Objective To identify and synthesise the range of barriers and facilitators to physical activity participation. Methods Systematic review of qualitative studies on the perspectives of physical activity among people aged 60 years and over. MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched. Independent raters assessed comprehensiveness of reporting of included studies. Thematic synthesis was used to analyse the data. Results From 132 studies involving 5987 participants, we identified six major themes: social influences (valuing interaction with peers, social awkwardness, encouragement from others, dependence on professional instruction); physical limitations (pain or discomfort, concerns about falling, comorbidities); competing priorities; access difficulties (environmental barriers, affordability); personal benefits of physical activity (strength, balance and flexibility, self-confidence, independence, improved health and mental well-being); and motivation and beliefs (apathy, irrelevance and inefficacy, maintaining habits). Conclusions Some older people still believe that physical activity is unnecessary or even potentially harmful. Others recognise the benefits of physical activity, but report a range of barriers to physical activity participation. Strategies to enhance physical activity participation among older people should include (1) raising awareness of the benefits and minimise the perceived risks of physical activity and (2) improving the environmental and financial access to physical activity opportunities.

https://bjsm.bmj.com/content/bjsports/49/19/1268.full.pdf

Older people's perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature

(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations)









There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

/pdf/evidence-based-clinical-guidelines-for-immigrants-and-200zq1p7iy.pdf

Evidence-based clinical guidelines for immigrants and refugees

Introduction Increasing physical activity is a goal of Healthy People 2010. Although the health benefits of physical activity are documented, older adults are less physically active than any other age group. The purpose of this study was to examine barriers and facilitators to physical activity and exercise among underserved, ethnically diverse older adults. Methods Seventy-one older adults were recruited through community agencies to participate in seven ethnic-specific focus groups: American Indian/Alaska Native, African American, Filipino, Chinese, Latino, Korean, and Vietnamese. Groups were conducted in the participants' primary language and ranged in size from 7-13 participants. Mean age was 71.6 years (range from 52 to 85 years; SD +/- 7.39). Professional translators transcribed audiotapes into the language of the group and then translated the transcript into English. Transcripts were systematically reviewed using content analysis. Results Suggested features of physical activity programs to enhance participation among ethnically diverse minority older adults included fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development. Walking was the exercise of choice across all ethnic groups. Health served as both a motivator and a barrier to physical activity. Other factors influencing physical activity were weather, transportation, and personal safety. Conclusion Findings from this study suggest strategies for culture-specific programming of community-based physical activity programs.

Older adult perspectives on physical activity and exercise: voices from multiple cultures.

Improving the health status of minority populations in the United States is a major public health challenge. This report describes an anthropological approach to obtaining information needed for designing and evaluating a culturally appropriate dietary intervention for Chinese-Americans. Ninety-minute qualitative interviews were conducted with 30 less-acculturated Chinese-American women in their native language (Cantonese or Mandarin), soliciting information from participants regarding usual food consumption; knowledge, attitude, and beliefs about diet and disease; and factors that influence food choices. Interviews were recorded, translated, transcribed, and coded for themes. Two focus groups with 6 participants each were conducted to cross-validate the interview findings. Among our participants, breakfast was usually the first meal to be "Westernized," largely for reasons of convenience. Food quality, cost, and availability were some of the most important predictors of dietary change after immigration to the United States. Respondents said that there was a strong connection between diet and disease. However, they were not familiar with US dietary guidelines, food labels, or other sources of dietary information, but reported that friends and Chinese newspapers were their primary source of nutrition information. We used these findings to develop quantitative dietary survey instruments adapted for Chinese-Americans. This type of qualitative groundwork is an important precursor to the design, implementation, and evaluation of dietary interventions for minorities. J Am Diet Assoc. 2000; 100: 934-940 .

Use of Qualitative Methods to Study Diet, Acculturation, and Health in Chinese-American Women

Asian populations living in the United States share similar cultural values that influence their experiences with domestic violence. However, it is critical to recognize how differential cultural beliefs in the context of immigration and adjustment to life in the United States affect attitudes, interpretations, and response to domestic violence. This article discusses findings from community-based participatory action research that explores how Cambodian immigrant women talk about domestic violence, what forms of abuse contribute to domestic violence, and what strategies they use to cope with and respond to abuse in their lives. The richness of this research lies in the stories that immigrant women tell about their struggle and their strength in addressing domestic violence.

“Women Must Endure According to Their Karma” Cambodian Immigrant Women Talk About Domestic Violence

This article discusses the experiences of domestic violence among Ethiopian refugees and immigrants in the United States. A subset (n = 18) of the larger study sample (N = 254) participated in three focus groups with Amharic-speaking survivors of domestic violence who were currently in or had left abusive relationships. The research was conducted through a public health department, University, and community agency partnership. Findings show domestic violence as taking place within a context of immigration, acculturation, and rapid changes in family and social structure. Participants expressed a need for language and culture-specific domestic violence support and advocacy as well as education programs regarding U.S. laws and resources.

“For Us It Is Like Living in the Dark” Ethiopian Women’s Experiences With Domestic Violence

In recent years, a growing literature has emerged that explores the role of culture in domestic violence for ethnic minority populations, including immigrants and refugees. This article presents qualitative data collected from Vietnamese refugee women through a research project in partnership with the Refugee Women's Alliance in Seattle, Washington. Through the women's stories, their own self-awareness of domestic violence as Vietnamese women residing in the United States is available for reflection and review. Issues of acculturation, changing gender roles, examples of strength, and cultural persistence constitute the thematic structure within which these women articulate their needs for creating and sustaining a life free of abuse for themselves and their children.

Sharyne Shiu-Thornton

Papers

Older adult perspectives on physical activity and exercise: voices from multiple cultures.

Use of Qualitative Methods to Study Diet, Acculturation, and Health in Chinese-American Women

“Women Must Endure According to Their Karma” Cambodian Immigrant Women Talk About Domestic Violence

“For Us It Is Like Living in the Dark” Ethiopian Women’s Experiences With Domestic Violence

“Like a Bird in a Cage” Vietnamese Women Survivors Talk About Domestic Violence