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. Author manuscript; available in PMC: 2015 Jan 1.
Published in final edited form as: Am J Mens Health. 2014 Jan;8(1):35–44. doi: 10.1177/1557988313489132

Physical Activity among Somali Men in Minnesota: Barriers, Facilitators and Recommendations

Ahmed A Mohamed 1, Abdullahi M Hassan 2, Jennifer A Weis 3, Irene G Sia 3, Mark L Wieland 3,*
PMCID: PMC3978682  NIHMSID: NIHMS567622  PMID: 23697961

Abstract

Immigrants and refugees arrive to the US healthier than the general population, but this advantage declines with increasing duration of residence. One factor contributing to this decline is sub-optimal physical activity, but reasons for this are poorly understood. Persons from Somalia represent the largest African refugee population to the United States, yet little is known about perceptions of physical activity among Somali men. Somali members of a community-based participatory research partnership implemented three age-stratified focus groups and three semi-structured interviews among 20 Somali men in Rochester, MN. Team-based inductive analysis generated themes for barriers and facilitators to physical activity. Barriers to physical activity included less walking opportunities in the US, embarrassment about exercise clothing and lack of familiarity with exercise equipment/modalities, fear of harassment, competing priorities, facility costs, transportation, and winter weather. Facilitators to physical activity included high knowledge about how to be active, success stories from others in their community as inspiration, and community cohesion. Findings may be used to derive interventions aimed to promote physical activity among Somali men in the US.

Keywords: Physical activity, Somali, Men, Community-based participatory research

INTRODUCTION

Immigrant and refugee populations arrive to the US with healthier cardiovascular risk profiles than the general population (Singh & Siahpush, 2001), but this advantage tends to decline with increasing duration of residence. This is highlighted by worsening of cardiovascular risk after immigration, including rising rates of obesity (Goel, McCarthy, Phillips, & Wee, 2004; Kaplan, Huguet, Newsom, & McFarland, 2004), hyperlipidemia (Koya & Egede, 2007), hypertension (Steffen, Smith, Larson, & Butler, 2006), diabetes (Creatore et al., 2010), and cardiovascular disease (Lear, Humphries, Hage-Moussa, Chockalingam, & Mancini, 2009; Lutsey et al., 2008).

Since the initiation of civil war in 1991, people from Somalia have comprised one of the largest refugee populations in the world. While the majority of these refugees remain in the region, Somali people represent one of the largest refugee populations to resettle in North America over this time period (United Nations Refugee Agency, 2011). Somali immigrants and refugees have been the fastest growing subset of African migration to the US in the past decade. For multiple reasons, including active social service organizations (“voluntary agencies”) who partner with the US State Department for refugee resettlement, approximately one-third of Somali refugees reside in Minnesota (Minnesota Department of Administration, 2010). Little is known about prevalence of cardiovascular risk factors among Somali immigrants and refugees to regions outside Africa. A small study of Somali psychiatric patients in the US found a high prevalence of diabetes and hypertension compared with non-Somali patients (Kinzie et al., 2008). Likewise, a study of Somali women living in New Zealand documented high prevalence of overweight and obesity (Guerin, Elmi, & Corrigan, 2007). In general populations, low levels of physical activity and sub-optimal dietary behaviors are associated with elevated cardiovascular risk (Andersen et al., 2006; Haskell et al., 2007; Lichtenstein et al., 2006), and addressing physical activity and nutrition represent two objectives and components of two of the four overarching goals of Healthy People 2020 (Fielding & Kumanyika, 2009; Healthy People 2020: Framework). Among immigrant and refugee populations to high income nations, physical activity levels are less healthy than the non-immigrant majority populations (Centers for Disease Control and Prevention, 2005; Crespo, Smit, Andersen, Carter-Pokras, & Ainsworth, 2000; Gadd, Sundquist, Johansson, & Wändell, 2005; Sternfeld, Ainsworth, & Quesenberry, 1999), and studies report that interventions aimed at increasing physical activity within 10 years of arrival may be particularly fruitful (Goel et al., 2004). While little is known about physical activity behaviors among Somali immigrants and refugees, qualitative work among Somali women and youth suggest sub-optimal physical activity levels after re-settlement to the US (Devlin et al., 2012; Rothe et al., 2010). These studies and others (Brophy et al., 2011; Wieland et al., 2012a) have described perceptions of physical activity and challenges to being physically active after immigration among these same demographics. However, there are no data (to our knowledge) regarding physical activity among Somali men.

One difficulty in designing interventions to promote physical activity and nutrition is that the reasons for sub-optimal behaviors are multiple, complex, and poorly understood among immigrant and refugee populations (Dunn & Dyck, 2000; Malmusi, Borrell, & Benach, 2010). Community-based participatory research (CBPR) is a means to collaboratively investigate this complexity within a community, whereby community members and academics partner in an equitable relationship through all phases of the research and programming process (Horowitz, Robinson, & Seifer, 2009; Israel, Schulz, Parker, & Becker, 1998; Shalowitz et al., 2009). This is an approach to research that is particularly well suited to work that addresses the interplay between health behaviors and the social determinants of health (circumstances in which people live that are shaped by the local and global distribution of power and resources that influence health and health inequity) such that it promotes understanding of locally pertinent issues, and organically targets the multi-faceted barriers to health (Krieger et al., 2002; Minkler, 2005; Wallerstein & Duran, 2006; Wells & Jones, 2009). Furthermore, results of existing literature suggest that CBPR is an effective means of approaching health topics among immigrant and refugee populations (Cristancho, Garces, Peters, & Mueller, 2008; Gregg et al.; Johnson, Ali, & Shipp, 2009; Lam et al., 2003; Lauderdale, Kuohung, Chang, & Chin, 2003; Martinez & Carter-Pokras, 2006; Wieland et al., 2013; Wieland et al., 2011). CBPR (engaged through an established partnership) is the approach for our study.

In 2010, our CBPR partnership completed a pilot program that was informed by focus groups to promote physical activity among immigrant and refugee women (Wieland et al., 2012a). While debriefing this project, interest was generated among the RHCP Somali community partners to engage men in a similar process. Therefore, focus groups were planned with men from the Rochester Somali community to determine their perceptions about physical activity. An ecological framework that recognizes the multiple influences on physical activity behaviors among Somali men (intrapersonal, interpersonal, community, policy) was adapted to inform the discussions (McLeroy, Bibeau, Steckler, & Glanz, 1988). This framework has been frequently applied to assessment and intervention about physical activity in community settings and among immigrant and refugee populations (Lopez, Bryant, & McDermott, 2008; Sallis et al., 2006). The aim of the study was to elucidate perceived barriers and facilitators to physical activity for Somali men in Rochester, MN. We also aimed to engage Somali men in the process of providing specific advice for potential programmatic components of a men’s health program in Rochester.

METHOD

Study Setting and CBPR Partnership

In 2004, a community-academic partnership developed between Mayo Clinic and Hawthorne Education Center (HEC), an adult education center that serves approximately 2500 immigrant and refugees per year in Rochester, MN, a small urban community in the Midwest United States. Between 2005 and 2007, this partnership matured by establishing operating norms and meeting schedules, adapted CBPR principles, and added many dedicated partners to form Rochester Healthy Community Partnership (RHCP). The mission of RHCP is to promote health and well-being among the Rochester community through CBPR, education, and civic engagement to achieve health for all (www.rochesterhealthy.org). Since 2007, RHCP has become productive and experienced at deploying data-driven programming and assessment among immigrant and refugee populations (Wieland et al., 2012a; Wieland et al., 2011). Community and academic partners conduct every phase of research together.

Focus Groups

Focus group questions were written by community and academic partners working together to elucidate the multiple influences on the decisions of men in their communities to be physically active. Specifically, the main questions asked participants to discuss things that are difficult about being physically active for Somali men in Rochester (barriers) and things that make it easier to be physically active for this same population (facilitators). Follow-up questions and probes were aimed at addressing all possible spheres of influence on physical activity. This study was approved by the Mayo Clinic Institutional Review Board.

Two Somali RHCP community partners (A.M., A.H.) recruited a convenience sample of Somali men for three age-stratified focus groups to elicit perceived facilitators and barriers to physical activity. The participants were recruited at a regional Mosque through solicitation via personal contacts of the community partners. Focus groups were conducted in the Mosque and the meeting rooms of two apartment buildings with predominately Somali tenants. These locations were chosen for the study participants’ convenience. Focus groups were facilitated by Somali moderators and note-takers (A.M., A.H.) who were trained through an RHCP program in focus groups moderation (Amico et al., 2011). Our experience with this training program and its application in our community suggest that focus groups are an effective means of qualitative inquiry among Somali participants (Wieland et al., 2012b). Focus groups were conducted in English with younger men and in the Somali language with older men.

Semi-Structured Interviews

While the focus groups data provided information on factors contributing to physical activity among Somali men and recommendations for programming, we further explored select themes elucidated in the focus groups through semi-structured interviews in order to confirm some of these findings. We aimed to further hone the perceived barriers and facilitators to physical activity among Somali men, to explore the role of community in promoting physical activity among Somali men, to explore the perceptions of harassment and embarrassment as they relate to physical activity among Somali men, and to compare perceptions of physical activity between Somali elders and young men. These objectives were derived from preliminary focus group results.

Participant recruitment was conducted in the same manner described for the focus groups. The first two interviews were held separately in a Mosque while the third interview was conducted at the home of an elder member of the Somali community. Interviews were conducted by the same Somali investigator (A.M.) who moderated the focus groups.

Data Analysis

Focus groups and interviews were audio recorded, translated (if applicable) and transcribed by a Somali community partner (A.M.). The analysis team consisted of one RHCP Somali community member trained in qualitative analysis (A.M.) and one academic partner (M.W.). After reading all transcripts and field notes in full, each analyst derived a code list that was debated until a consensus code list was created. Transcripts and field notes were then double-coded by the analysts. An evaluative approach was used to elucidate the multilevel influences that shape barriers and facilitators to being physically active among Somali men in Minnesota. Final themes and sub-themes were derived through a deliberative process of inductive analysis among analysts (Patton, 1990). Analysis was facilitated by NVIVO-9 software (QSR International). Based on all data, the authors derived recommendations for physical activity promotion among Somali men in the United States.

RESULTS

Seventeen Somali men participated in the focus groups. Participants (n=5, 29%) in the first focus group ranged in age from 28 to 65 while participants in focus groups two (n=7, 42%) and three (n=5, 29%) were separated into younger (ages 24 to 30) and elder Somali men (ages 29 to 58), respectively. Three Somali men ages 24, 25, and 56, from the Rochester, Minnesota Somali community participated in semi-structured interviews.

Barriers to Physical Activity

Participants described barriers to being physically active across multiple levels. At the intrapersonal level, all participants agreed that physical activity and exercise were not top priorities in the lives of Somali men. Upon immigration, the top priority was employment so that families may be supported in the US and in Africa. Participants conveyed that once employment and financial security are achieved, it is difficult to re-adjust priorities to include physical activity. Participants in two focus groups agreed that embarrassment to exercise was a significant interpersonal barrier to being physically active. Participants stated that older Somali men (above 30 years of age) were often concerned about wearing the standard exercising attire in the United States. They felt uncomfortable in tight-fitting clothing which Somalis do not traditionally wear. For example, Participant 4 in focus group 3 said, “If you give an old (Somali man) a pair of shorts and Somali women see him running, Somali women would say he is crazy...” Further, participants relayed embarrassment with the act of initiating a set of exercise behaviors with which they are not familiar, e.g., running for exercise or going to the gym. At the community level, older participants in one focus group talked extensively about how they walked less on a daily basis as compared to when they lived in Somalia where people walked routinely to the market, school, work, etc. They generally lamented the fact that these habits had been lost. Participant 4 in focus group 3 stated that “(there is a) lack of exercise because the life here is different, and back home, it was about walking…” Participants in the same focus group stated that a related community197 level barrier was a fear of harassment while walking or exercising. Instances of harassment experienced by Somalis in the United States have raised concerns about performing physical activity in public. Elder Somali men voiced concerns about harassment and being targeted because of their appearance by non-Somalis. They spoke extensively about this topic, which was confirmed by the interviewees. Participant 3 in focus group 3 said, “…my elderly mother used to walk to the mosque in the early morning... a car chased her and her friend as they walked… It was a man in a pick-up truck who was insulting them as they walked home. They refused to walk there again after that incident.” Organizational or policy-level barriers to physical activity stated by participants included cost of workout facility memberships and transportation. The majority of participants expressed concern for the elder men in the Somali community who were not able to drive or walk long distances to gatherings or facilities where men may engage in physical activity. For the younger men, transportation was not a barrier. Themes related to barriers to physical activity and representative quotes are presented in Table 1.

Table 1.

Perceived barriers to physical activity among Somali men living in Minnesota

Theme Summary Representative quotes
Competing priorities Physical activity is not a top priority in their lives. Upon immigration, the primary priority is employment so that families may be supported in the US and in Africa. Group 3, participant 4: “… We all know that exercise leads to good health. Then again, people cannot keep it up. They won’t have time, are looking for food, or a job and paycheck.”

Group 3, participant 2: “Most of us are diabetic because of the stress of not working, having to support family in Africa while paying bill here…”
Cost Cost of being physically active was a barrier to utilization of exercise facilities. This is particularly relevant in the winter months. Group 2, participant 4: “I think I have time to go to the gym, but I don’t think I can afford it.”
Transportation for elders Many elder men in the Somali community are not able to drive or walk long distances to gatherings or facilities where men may engage in physical activity. For the younger men, transportation is not a barrier. Group 1, participant 1: “…elder men would most likely need transportation․… It would be difficult for them not to go without transportation.”

Group 1, participant 3: “If there could be transportation, the elder would come.”
Embarrassed to exercise Wearing clothes and engaging in exercise for the first time was seen as embarrassing for older participants. Group 3, participant 3: “Because of the culture, you cannot show, you know, certain parts of your body, so you don’t feel comfortable.”

Group 3, participant 4: “If you give an old (Somali man) a pair of shorts and Somali women see him running, Somali women would say he is crazy…”
Fear of harassment Elder Somali men voiced concerns about harassment by non-Somalis and being targeted for insults because of their appearance Group 3, participant 3: “…my elderly mother used to walk to the mosque in the early morning… a car chased her and her friend as they walked… It was a man in a pick-up truck who was insulting them as they walked home. They refused to walk there again after that incident.”

Group 3, participant 1: “Well, some of them, they had the fear after the 9/11 because there were a lot of Arabs and some said we might become a target.”

Group 3, participant 2: “People will be suspicious seeing a large group (of Somali men) walking together and ask questions.”
People walk less Participants walked less on a daily basis as compared to when they lived in Somalia where people walked routinely to the market, school, work, etc. Group 3, participant 3: “…Somali people have always been walking throughout their land, you know, back home. Here, because of uh…automobiles and all of that…”

Group 3, participant 4: “… Lack of exercise because of the life here is different, and back home, it was about walking…”
Winter weather Cold weather during the winter season in the United States was seen as a significant barrier to physical activity. Group 3, participant 5: “…Everyday was summer in Somalia… We weren’t driving, so there was a lot of walking. Here, everyone is driving, hiding from the cold, and as a result, they are suffering from things like high cholesterol. … So, the weather here is an issue.”
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Facilitators to Physical Activity

Participants described several things that promote physical activity in their community. At the intrapersonal level, participants in every focus group stated that knowledge about physical activity and attitudes about the importance of physical activity were both relatively high within their community. Participant 5 in focus group 2 said, “There’s a lot of ways you can do exercise… depends if you run a lot or if play soccer or any kind of sports can be, you know, fitness. Anything you can lose a lot of calories, or weight, or anything like that.” Participants said it is well known among Somali men that physical activity is important for prevention and control of diabetes, weight loss, increased strength, stress reduction, improved sleep, etc. Likewise, participants were generally familiar with mechanics and techniques for engaging in physical activity, e.g., walking, sports, etc. However, younger men were more likely to conceive of physical activity as sports and exercise while the elders were more likely to conceive of physical activity more broadly to include work or chores around the home. Nevertheless, because of the perceived health benefits, physical activity was deemed to be very important among Somali men. At the interpersonal level, participants stated that hearing about or witnessing Somali men who have become successful at being physically active was motivating to other men who were not physically active. Stated reasons for this motivation included a sense of competition to “keep up” with their peers in the context of a rapid “word of mouth” reporting mechanism within the community. Participant 3 in focus group 3 said, “we only go by word of mouth. We pass on information that way. We also have the attitude “someone else did it, you can do it also.” At the community level, participants in one focus group stated that a strong sense of community advocacy could help promote physical activity. Participants said that news travels quickly within the Somali community since most families and individuals live together in apartment complexes or socialize after prayers at Mosques or markets. This was perceived to be a supportive infrastructure for incorporation of healthy behaviors like physical activity. Participant 5 in focus group 3 stated, “I think the most beneficial one will be as a group, believe me. We Somalis usually like going as groups to places…” Themes related to facilitators to physical activity and representative quotes are presented in Table 2.

Table 2.

Perceived facilitators to physical activity among Somali men living in Minnesota

Theme Summary Representative quotes
Knowledgeable about Benefits and Techniques Participants perceived themselves to be knowledgeable about the benefits of physical activity, including prevention and control of diabetes, weight loss, increased strength, stress reduction, improved sleep, etc. Likewise, participants were generally familiar with mechanics and techniques for engaging in physical activity, e.g., walking, sports, etc. Group 2, participant 5: “There’s a lot of ways you can do exercise… depends if you run a lot or if play soccer or any kind of sports can be, you know, fitness. Anything you can lose a lot of calories, or weight, or anything like that.”

Group 3, participant 4: “I am diabetic… I walk about 1.5 miles per day. Other exercises I do are at home, with my wife and kids, when I am cooking, doing laundry, or jumping around with the kids. Both exercise and work are very good for the health.”
Physical activity is deemed as important Participants consider it very important to be physically active in one’s life. Group 2, participant 2: “Most important thing to do is lifestyle habits that you can change and also exercising as well…When I talk about lifestyle habits, I mean like inputs and outputs. Your intake of amount of food that you certainly consume should also reflect the amount of exercise you do. If apparently you cannot work out as much or do as much exercise, you should cut down on your intake.”

Group 3, participant 1: “The most important thing we talked about is the exercise, fitness, and what Mr. A. said about how we can get people to participate. Also communication with other people and that exercise is very very important especially in the state that we are living here.”
Success stories as inspiration Seeing other Somali men succeed at being physically active was reported to be highly motivating to participants. Group 3, participant 2: “My opinion is when these people succeed with one person either team either middle group either elders, when we get someone who succeeds in exercise and the people can see or watch they will follow.”

Group 3, participant 3: “We only go by word of mouth. We pass on information that way. We also have the attitude “someone else did it, you can do it also.”
Community cohesion News travels quickly within the Somali community since most families and individuals live together in apartment complexes or socialize after prayers at Mosques or markets. This was perceived to be a supportive infrastructure for incorporation of healthy behaviors like physical activity. Group 3, participant 3: “I think the mosque could play a vital role in promoting this, especially when they come out. You know how the Somalis are; they like to talk before they go home (after prayer). That’s one area where people could start talking about the fitness and walk around two or three blocks while talking…”

Group 3, participant 5: “I think the most beneficial one will be as a group, believe me. We Somalis usually like going as groups to places…”
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Recommendations to improve physical activity

Since focus group questions were developed in response to a past fitness program, questions that asked participants to convey recommendations for improving physical activity among Somali men were primarily answered with suggestions for programming (organizational/community level change) as opposed to recommendations to address all of the multi-level barriers and facilitators described above. Participants in all focus groups agreed that Somali men (in general) would not be motivated to attend structured group exercise classes. This was particularly true for older men. That being said, participants stated that exercise programs would only be successful if they involved groups of men. Participants in all focus groups said that this could be achieved through programming that included a broad “menu” of aerobic exercises, strength training, and team-based activities. This diversity of options was seen as preferential to a narrow focus. Further, participants in one focus group stated that a “buddy system” whereby individual men were accountable to a group of men for attendance would promote participation and socialization. Participants were split about whether physical activity programs should be designed with Somali men only versus engaging other immigrant and non-immigrant communities. Participants in all groups agreed that it would be important to use physical activity programming as an opportunity to integrate members of diverse communities. While all participants agreed that this would be preferable for younger Somali men, participants stated that older men may be uncomfortable exercising among people from different languages and cultures. Finally, participants in all groups recommended organized walking groups as a means to engage older Somali men in regular physical activity. These recommendations and recommendations derived by the authors in response to barriers and facilitators to physical activity are shown in Table 3.

Table 3.

Recommendations for physical activity promotion among Somali men

Organizational level

  • Assure a “critical mass” of Somali participants to avoid sociolinguistic isolation and embarrassment.

  • Foster acceptance of non-standard exercise clothing.

  • Facilitate opportunities for a broad “menu” of individual aerobic exercises, strength training, and team-based activities.

  • Assign exercise guides (coaches) for exercise opportunities.

  • Develop a “buddy system” for accountability and socialization.

  • Avoid structured group exercise classes.

  • Incorporate walking groups into programs, particularly with elders.

  • Explore low-cost options for exercise.

  • Facilitate transportation (e.g., community-based car pooling) for elders.

  • Maintain rigorous indoor physical activity options, particularly in the winter.

Community level

  • Draw on existing channels of community advocacy within the Somali community to lead and facilitate “word of mouth” action.

  • In spite of obstacles, promote physical activity as an opportunity to embrace and integrate with the broader, non-Somali communities.

  • Maintain an atmosphere of complete intolerance for harassment of and false assumptions about a group of Somali men.

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DISCUSSION

This community-based participatory study is the first (to our knowledge) to report the perceptions of physical activity among Somali men while providing specific barriers and facilitators to being physically active in the United States. These data may inform programming aimed at sustaining or improving physical activity among Somali men after immigration (Table 3).

Study participants were united in recognizing the importance of physical activity for health. Likewise, participants felt confident about their physical activity knowledge. This implies that future interventions to promote physical activity among Somali men should not focus purely on education; but rather, they should seek to strengthen the existing individual and community-based facilitators to physical activity while mitigating the complex personal, inter-personal, and community level barriers.

We found that competing priorities for time and money were significant barriers to physical activity. Somali men reported feeling a strong obligation to provide financial security to their families in both the US and Africa. Therefore, time dedicated to physical activity, particularly in the first months and years following immigration are in direct competition with seeking and sustaining employment. Once these employment and social schedules in a new country are established, it is difficult to change behaviors. This behavior change is further thwarted by the cost of athletic facility memberships, which are particularly important in cold weather climates. These patterns are at odds with existing evidence that physical activity behaviors should be shaped as soon as possible following immigration (Goel et al., 2004). So, efforts to promote physical activity should be synergistic with the busy employment265 focussed cycle of the day, while avoiding reliance on expensive facility memberships.

Our results suggest that one way to avoid these facility memberships while promoting physical activity is through the creation of walking groups. Participants lamented the loss of walking they had experienced in Africa. Walking groups would draw on the strong structure of community advocacy and social cohesion reported by participants. While not uniformly experienced, the alarming findings that fear of harassment may be a barrier to walking groups should be addressed as a community-wide effort that promotes inclusivity and safety for all residents.

In Minnesota (and much of the US), outdoor-based physical activity becomes undesirable, impractical, or expensive during winter months. While walking groups can be arranged indoors (e.g., malls), there was a desire among participants to extend physical activity experiences to a broad range of activities at exercise facilities. In addition to cost and transportation, barriers to physical activity in these settings included embarrassment by a lack of familiarity with indoor exercise equipment and norms (e.g., clothing, programming, etc). These findings are consistent with previous work among Somali women (Devlin et al., 2012). Therefore, future programming should assure a “critical mass” of Somali participants to avoid sociolinguistic isolation and embarrassment while guiding men through a wide range of physical activity and exercise opportunities. Our findings suggest that younger Somali men who grew up mostly in the US are potential guides for community elders or recent immigrants, since they are reportedly unaffected by these barriers.

Physical activity among Somali men cannot be viewed in isolation from other wellness principles, particularly eating a healthy diet, managing stress, and achieving adequate sleep. Participants were clear that a balance between these principles is essential for improved overall health. Therefore, multi-component programming may have the greatest likelihood of influencing behavior change across any of those domains, including physical activity. Somali men share information on a daily basis at the Mosque, coffee shops, and markets. Success stories about a holistic health program may inspire community members to participate.

This study is limited by a relatively small sample size, highlighting the fact that these data and associated conclusions are not a comprehensive exploration of the topic. Further, though focus groups and interviews were age-stratified, recruitment was based on a convenience sample. While every source lent important information, a single focus group (focus group 3) provided data that was significantly richer than the others. Finally, focus groups and interviews were conducted among men from a single community. These limitations collectively have implications for generalizability to all Somali men and communities.

CONCLUSION

In summary, competing priorities, cost, transportation concerns, embarrassment about using unfamiliar clothes and exercise techniques in public, fear of harassment, winter weather and less daily walking opportunities were seen as barriers to optimal physical activity among Somali men. These barriers may be mitigated by existing positive attitudes about the importance of physical activity, exposure to success stories in their community, and community cohesion towards a common goal. These findings may be used as cues to action for CBPR partnerships and public health agencies to derive interventions aimed at promoting physical activity among Somali immigrant and refugee men.

ACKNOWLEDGEMENTS

This project was supported by the National Institutes of Health through a Partners in Research grant, R03 AI082703 and by Clinical and Translational Science Award (CTSA) Grant UL1-RR-024150 (to the Mayo Clinic).

REFERENCES

  1. Amico KL, Wieland ML, Weis JA, Sullivan SM, Nigon JA, Sia IG. Capacity building through focus group training in community-based participatory research. Education for health. 2011;24(3):638. [PMC free article] [PubMed] [Google Scholar]
  2. Andersen LB, Harro M, Sardinha LB, 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(9532):299–304. doi: 10.1016/S0140-6736(06)69075-2. [DOI] [PubMed] [Google Scholar]
  3. Brophy S, Crowley A, Mistry R, Hill R, Choudhury S, Thomas NE, et al. Recommendations to improve physical activity among teenagers--a qualitative study with ethnic minority and European teenagers. BMC Public Health. 2011;11:412. doi: 10.1186/1471-2458-11-412. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Centers for Disease Control and Prevention. Prevalence of fruit and vegetable consumption and physicial activity by race/ethnicity-United States. Morbidity and Mortality Weekly Report. 2005;56:301–304. [PubMed] [Google Scholar]
  5. Creatore MI, Moineddin R, Booth G, Manuel DH, DesMeules M, McDermott S, et al. Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ. 2010;182(8):781–789. doi: 10.1503/cmaj.091551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE. 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. Am J Prev Med. 2000;18(1):46–53. doi: 10.1016/s0749-3797(99)00105-1. [DOI] [PubMed] [Google Scholar]
  7. Cristancho S, Garces DM, Peters KE, Mueller BC. Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use. Qual Health Res. 2008;18(5):633–646. doi: 10.1177/1049732308316669. [DOI] [PubMed] [Google Scholar]
  8. Devlin JT, Dhalac D, Suldan AA, Jacobs A, Guled K, Bankole KA. Determinants of physical activity among Somali women living in Maine. J Immigr Minor Health. 2012;14(2):300–306. doi: 10.1007/s10903-011-9469-2. [DOI] [PubMed] [Google Scholar]
  9. Dunn JR, Dyck I. Social determinants of health in Canada's immigrant population: results from the National Population Health Survey. Soc Sci Med. 2000;51(11):1573–1593. doi: 10.1016/s0277-9536(00)00053-8. [DOI] [PubMed] [Google Scholar]
  10. Fielding J, Kumanyika S. Recommendations for the concepts and form of Healthy People 2020. Am J Prev Med. 2009;37(3):255–257. doi: 10.1016/j.amepre.2009.04.029. [DOI] [PubMed] [Google Scholar]
  11. 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(6):535–541. doi: 10.1097/01.hjr.0000174829.25388.ed. [DOI] [PubMed] [Google Scholar]
  12. Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860–2867. doi: 10.1001/jama.292.23.2860. [DOI] [PubMed] [Google Scholar]
  13. 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. Prog Community Health Partnersh. 4(2):149–154. doi: 10.1353/cpr.0.0116. [DOI] [PubMed] [Google Scholar]
  14. Guerin PB, Elmi FH, Corrigan C. Body composition and cardiorespiratory fitness among refugee Somali women living in New Zealand. J Immigr Minor Health. 2007;9(3):191–196. doi: 10.1007/s10903-006-9030-x. [DOI] [PubMed] [Google Scholar]
  15. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, 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(9):1081–1093. doi: 10.1161/CIRCULATIONAHA.107.185649. [DOI] [PubMed] [Google Scholar]
  16. Healthy People. Framework. [Retrieved January 9, 2011];2020 from http://www.healthypeople.gov/2020/Consortium/HP2020Framework.pdf.
  17. Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream: are researchers prepared? Circulation. 2009;119(19):2633–2642. doi: 10.1161/CIRCULATIONAHA.107.729863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202. doi: 10.1146/annurev.publhealth.19.1.173. [DOI] [PubMed] [Google Scholar]
  19. Johnson CE, Ali SA, Shipp MP. Building community-based participatory research partnerships with a Somali refugee community. Am J Prev Med. 2009;37(6) Suppl 1:S230–S236. doi: 10.1016/j.amepre.2009.09.036. [DOI] [PubMed] [Google Scholar]
  20. Kaplan MS, Huguet N, Newsom JT, McFarland BH. The association between length of residence and obesity among Hispanic immigrants. Am J Prev Med. 2004;27(4):323–326. doi: 10.1016/j.amepre.2004.07.005. [DOI] [PubMed] [Google Scholar]
  21. Kinzie JD, Riley C, McFarland B, Hayes M, Boehnlein J, Leung P, et al. High prevalence rates of diabetes and hypertension among refugee psychiatric patients. The Journal of nervous and mental disease. 2008;196(2):108–112. doi: 10.1097/NMD.0b013e318162aa51. [DOI] [PubMed] [Google Scholar]
  22. Koya DL, Egede LE. Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants. J Gen Intern Med. 2007;22(6):841–846. doi: 10.1007/s11606-007-0163-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Krieger J, Allen C, Cheadle A, Ciske S, Schier JK, Senturia K, et al. Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities. Health Educ Behav. 2002;29(3):361–382. doi: 10.1177/109019810202900307. [DOI] [PubMed] [Google Scholar]
  24. Lam TK, McPhee SJ, Mock J, Wong C, Doan HT, Nguyen T, et al. Encouraging Vietnamese-American women to obtain Pap tests through lay health worker outreach and media education. J Gen Intern Med. 2003;18(7):516–524. doi: 10.1046/j.1525-1497.2003.21043.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lauderdale DS, Kuohung V, Chang SL, Chin MH. Identifying older Chinese immigrants at high risk for osteoporosis. J Gen Intern Med. 2003;18(7):508–515. doi: 10.1046/j.1525-1497.2003.20331.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lear SA, Humphries KH, Hage-Moussa S, Chockalingam A, Mancini GB. Immigration presents a potential increased risk for atherosclerosis. Atherosclerosis. 2009;205(2):584–589. doi: 10.1016/j.atherosclerosis.2008.12.037. [DOI] [PubMed] [Google Scholar]
  27. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82–96. doi: 10.1161/CIRCULATIONAHA.106.176158. [DOI] [PubMed] [Google Scholar]
  28. Lopez IA, Bryant CA, McDermott RJ. Influences on physical activity participation among Latinas: an ecological perspective. American journal of health behavior. 2008;32(6):627–639. doi: 10.5555/ajhb.2008.32.6.627. [DOI] [PubMed] [Google Scholar]
  29. Lutsey PL, Diez Roux AV, Jacobs DR, Jr, Burke GL, Harman J, Shea S, et al. Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Public Health. 2008;98(11):1963–1970. doi: 10.2105/AJPH.2007.123844. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010;71(9):1610–1619. doi: 10.1016/j.socscimed.2010.07.043. [DOI] [PubMed] [Google Scholar]
  31. Martinez IL, Carter-Pokras O. Assessing health concerns and barriers in a heterogeneous Latino community. J Health Care Poor Underserved. 2006;17(4):899–909. doi: 10.1353/hpu.2006.0129. [DOI] [PubMed] [Google Scholar]
  32. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health education quarterly. 1988;15(4):351–377. doi: 10.1177/109019818801500401. [DOI] [PubMed] [Google Scholar]
  33. Minkler M. Community-based research partnerships: challenges and opportunities. J Urban Health. 2005;82(2) Suppl 2:ii3–ii12. doi: 10.1093/jurban/jti034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Minnesota Department of Administration. Immigrants to Minnesota by region and selected country of birth. [Retrieved December 20, 2011];2010 from http://www.demography.state.mn.us/resource.html?Id=18679. [Google Scholar]
  35. Patton M. Qualitative Evaluation and Research Methods. Newbury Park, CA: Sage Publications; 1990. Designing qualitative studies; pp. 169–186. [Google Scholar]
  36. Rothe E, Holt C, Kuhn C, McAteer T, Askari I, O'Meara M, et al. Barriers to outdoor physical activity in wintertime among Somali youth. J Immigr Minor Health. 2010;12(5):726–736. doi: 10.1007/s10903-009-9287-y. [DOI] [PubMed] [Google Scholar]
  37. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annual review of public health. 2006;27:297–322. doi: 10.1146/annurev.publhealth.27.021405.102100. [DOI] [PubMed] [Google Scholar]
  38. Shalowitz MU, 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. J Dev Behav Pediatr. 2009;30(4):350–361. doi: 10.1097/DBP.0b013e3181b0ef14. [DOI] [PubMed] [Google Scholar]
  39. Singh GK, Siahpush M. All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health. 2001;91(3):392–399. doi: 10.2105/ajph.91.3.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Steffen PR, Smith TB, Larson M, Butler L. Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review. Psychosom Med. 2006;68(3):386–397. doi: 10.1097/01.psy.0000221255.48190.32. [DOI] [PubMed] [Google Scholar]
  41. Sternfeld B, Ainsworth BE, Quesenberry CP. Physical activity patterns in a diverse population of women. Prev Med. 1999;28(3):313–323. doi: 10.1006/pmed.1998.0470. [DOI] [PubMed] [Google Scholar]
  42. United Nations Refugee Agency. [Retrieved September 18, 2012];2011 from http://data.unhcr.org/horn-of-africa/somalia.php. [Google Scholar]
  43. Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006;7(3):312–323. doi: 10.1177/1524839906289376. [DOI] [PubMed] [Google Scholar]
  44. Wells K, Jones L. "Research" in community-partnered, participatory research. Jama. 2009;302(3):320–321. doi: 10.1001/jama.2009.1033. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Wieland ML, Nelson J, Palmer T, O'Hara C, Weis JA, Nigon JA, Sia IG. Evaluation of a tuberculosis video among immigrants and refugees at an adult education center: a community-based participatory research approach. Journal of Health Communication. 2013;18(3):343–353. doi: 10.1080/10810730.2012.727952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Wieland ML, Weis JA, Palmer T, Goodson M, Loth S, Omer F, et al. Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2012a;22(2):e225–e232. doi: 10.1016/j.whi.2011.10.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Wieland ML, Weis JA, Yawn BP, Sullivan SM, Millington KL, Smith CM, et al. Perceptions of Tuberculosis Among Immigrants and Refugees at an Adult Education Center: A Community-Based Participatory Research Approach. J Immigr Minor Health. 2012b;14(1):14–22. doi: 10.1007/s10903-010-9391-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Wieland ML, Weis JA, Olney MW, Aleman M, Sullivan SM, Millington KL, O'Hara C, Nigon JA, Sia IG. Prevalence of Latent Tuberculosis Infection at an Adult Education Center: Results from a Community-Based Participatory Process. American Journal of Public Health. 2011;101(7):1264–1267. doi: 10.2105/AJPH.2010.300024. [DOI] [PMC free article] [PubMed] [Google Scholar]

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