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Abstract

Immigrants and refugees arrive to the United States healthier than the general population, but this advantage declines with increasing duration of residence. One factor contributing to this decline is suboptimal 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 semistructured interviews among 20 Somali men in Rochester, Minnesota. Team-based inductive analysis generated themes for barriers and facilitators to physical activity. Barriers to physical activity included less walking opportunities in the United States, 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 United States.

Keywords

physical activity Somali men community-based participatory research

Introduction

Immigrant and refugee populations arrive to the United States 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. Whereas 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 United States in the past decade. For multiple reasons, including active social service organizations (“voluntary agencies”) who partner with the U.S. 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 United States 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 suboptimal 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, 2010). Among immigrant and refugee populations to high-income nations, physical activity levels are less healthy than the nonimmigrant 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). Although little is known about physical activity behaviors among Somali immigrants and refugees, qualitative work among Somali women and youth suggest suboptimal physical activity levels after resettlement to the United States (Devlin et al., 2012; Rothe et al., 2010). These studies and others (Brophy et al., 2011; Wieland, Weis, Palmer, et al., 2012) 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 suboptimal 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 multifaceted 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., 2010; Johnson, Ali, & Shipp, 2009; Lam et al., 2003; Lauderdale, Kuohung, Chang, & Chin, 2003; Martinez & Carter-Pokras, 2006; Wieland et al., 2011; Wieland et al., 2013). 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, Weis, Palmer, et al., 2012). 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, Minnesota. 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, an adult education center that serves approximately 2,500 immigrant and refugees per year in Rochester, Minnesota, 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, Weis, Palmer, et al., 2012; 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 (AM, AH) 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 (AM, AH) 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, Weis, Yawn, et al., 2012). Focus groups were conducted in English with younger men and in the Somali language with older men.

Semistructured Interviews

While the focus groups data provided information on factors contributing to physical activity among Somali men and provided recommendations for programming, we further explored select themes elucidated in the focus groups through semistructured interviews 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 whereas the third interview was conducted at the home of an elder member of the Somali community. Interviews were conducted by the same Somali investigator (AM) who moderated the focus groups.

Data Analysis

Focus groups and interviews were audio recorded, translated (if applicable), and transcribed by a Somali community partner (AM). The analysis team consisted of one RHCP Somali community member trained in qualitative analysis (AM) and one academic partner (MW). 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 subthemes 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 years whereas participants in focus groups two (n = 7, 42%) and three (n = 5, 29%) were separated into younger (ages 24-30) and elder Somali men (ages 29-58), respectively. Three Somali men aged 24, 25, and 56, from the Rochester, Minnesota, Somali community participated in semistructured 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. On immigration, the top priority was employment so that families may be supported in the United States and in Africa. Participants conveyed that once employment and financial security are achieved, it is difficult to readjust 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.” Furthermore, participants relayed embarrassment with the act of initiating a set of exercise behaviors with which they are not familiar, for example, 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, and so on. 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 community-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. On immigration, the primary priority is employment so that families may be supported in the United States 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, and so on.	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.”

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, and so on. Likewise, participants were generally familiar with mechanics and techniques for engaging in physical activity, for example, walking, sports. 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, and so on. Likewise, participants were generally familiar with mechanics and techniques for engaging in physical activity, for example, walking, sports, and so on.	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.”

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 multilevel 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 be successful only 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. Furthermore, 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 nonimmigrant 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. Although 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 nonstandard 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.

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, interpersonal, 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 United States and Africa. Therefore, time dedicated to physical activity, particularly in the first months and years following immigration, is 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 employment-focused 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. Although 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 United States), outdoor-based physical activity becomes undesirable, impractical, or expensive during winter months. Although 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 United States 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, multicomponent 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. Furthermore, 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 were 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 toward 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.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: 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).

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Physical Activity Among Somali Men in Minnesota

Abstract

Keywords

Introduction

Method

Study Setting and CBPR Partnership

Focus Groups

Semistructured Interviews

Data Analysis

Results

Barriers to Physical Activity

Facilitators to Physical Activity

Recommendations to Improve Physical Activity

Discussion

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

References