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Cultural ICANPD Classes Conclude and Reflection Begins

By Anne Dybsetter, Extension Educator — Health and Nutrition

This winter, a team of University of Minnesota Extension Health and Nutrition staff in southwest Minnesota wrapped up a series of diabetes prevention classes and information-gathering sessions with the aim of developing and testing cultural adaptations to better meet the needs of Minnesotans of Latino and Somali backgrounds.

As a team, we’re sifting through what we’ve learned since the project began in 2015. We learned that culturally adapting a program requires attention to numerous factors. Addressing many of these factors is doable — if challenging — and may lead to promising outcomes. Other factors just cannot easily be addressed within the structure of an existing curriculum. Even more challenging, some of these factors are not readily apparent or only emerge with time and reflection.

Curriculum, Classes, and Listening to the Community

Individuals and Communities Acting Now to Prevent Diabetes® (I CAN Prevent Diabetes or ICANPD) is the Minnesota name for the National Diabetes Prevention Program (NDPP). NDPP is a curriculum from the Centers for Disease Control and Prevention (CDC) to help people with prediabetes make lifestyle changes, such as eating healthfully and increasing physical activity, that are proven to reduce the risk of developing diabetes.

For the cultural adaptation project, an Extension team worked in two southwest Minnesota towns — Worthington and Willmar — to conduct focus groups, listen to community partners, and document the experiences of SNAP-Ed educators to better understand what works and what doesn’t when implementing the program with Latino and Somali groups.

Two participants in Letty's course
prepare a healthy recipe.
In Worthington, SNAP-Ed Educator Leticia (Letty) Rodriguez served as lifestyle coach for an ICANPD series for Latinos between July 2015 and June 2016. A cultural guide, Luz Cazares, assisted with implementation. In addition, SNAP-Ed educators who teach ICANPD in Spanish in other parts of the state were interviewed to better understand their experiences.

In Willmar, SNAP-Ed Educator Abdulahi Dohe served as lifestyle coach for Somali participants between February and November 2016. Metro-based SNAP-Ed Educators Nimo Yusuf and Hibaq Dualeh contributed many hours of thought and discussion to the adaptation process, along with two Willmar-based cultural guides, Anab Kilaas and Abdirizak Siyad. For both locations, participant focus groups were crucial in identifying how to make the program more relevant and useful.

Project Findings

First of all, the team learned that cultural adaptation can be challenging and demanding.

young muslim woman looking surprised

But we already knew that, didn’t we? Many of the community members with whom we work may speak languages other than English, may have limited literacy, and may be unfamiliar with community services and resources.

The team also found that adaptation of ICANPD for the two different cultural groups showed promising — but differing — outcomes. For Latino participants, the curriculum was already available in the Spanish language from CDC. Program implementation proved feasible with a Spanish-speaking educator to lead the course, and the project was enhanced by community partnerships. Participants showed an increase in physical activity and interest in other Extension programs.

For Somali participants, several aspects of the program, led by a Somali-speaking educator, were well-received. Participants embraced basic nutrition education and concepts like MyPlate and portion size. They too increased their physical activity and valued the positive results, which they said made them better able to accomplish daily tasks and prayers.

In both groups, however, participant weight loss outcomes trended in the right direction during the weekly sessions but did not achieve program goals.

Surface Differences and ‘Deep Structures’

In brief, the two adaptations of the ICANPD course were very different. Some reasons for the differences are obvious — we might think of these as “surface” differences.

For instance, Letty’s many years of service in Worthington provided her with long-established relationships that were readily leveraged to support the program. In Willmar, Abdulahi had lived and worked in the community for just nine months when the project began and needed time to invest in developing new relationships.

Literacy levels are another example: ICANPD asks participants to write down everything they eat on a daily basis. Among the Latino group, a majority of participants had adequate literacy skills to track food intake in writing, whereas in this case none of the Somali participants did.

As educators, we do our best to tailor programs to meet the needs of diverse audiences. Our experiences guide us to focus on familiar — and essential — strategies, like working with partners, providing transportation or child care, and addressing language and literacy issues.

The cultural adaptation project showed the importance of looking even further. Other factors, more difficult to make out and understand, are waiting quietly behind the surface differences. These are the “deep structures” of culture and life experience, rooted in belief systems, subtle differences in family and community structure, and variations in language and the meaning of words.

plant with exposed roots

For instance, did you know that in the Somali language, at least three words are necessary to talk about the fat in food? Or that traditional Islamic sayings, known as hadiths, encourage moderation and health? In this case, we found that deep structures made it more difficult to adapt the existing ICANPD program into an effective experience for the Somali group, and that additional pre-work or a different approach may sometimes be needed.

There is much more to learn and explore related to culture, health, and meeting the needs of Minnesotans of diverse cultures. The ICANPD project provided a snapshot of different ways that people from different backgrounds view health and face barriers, all of which contributes to future programming. Many thanks to all staff who contributed to this challenging work, and to the Minnesota Department of Health for funding support.

Cassie Silveira, Leticia Rodriguez, and Abdulahi Dohe contributed to this article.

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