The “SHINE” Project: A Model for Holistic Health Education in a Somali Adolescent Population

Background: Historically, immigrant and minority populations comprise a significant portion of the medically underserved in the United States. Factors, such as cultural differences, communication barriers, and inadequate understanding of US healthcare and basic health education, play a pivotal role in the observed health disparities. Somali refugees and immigrants in the US have one of the lowest levels of preventative health care utilization. Additionally, adolescents are a unique population with nascent opinions and behaviors that can be molded through targeted interventions. Here, we will discuss the effectiveness of a community health education program implemented in a Somali adolescent population. Our goal was to increase health education and foster interest and participation in personal health-promoting behaviors.

Methods: Somali Health Initiative and Nutrition Education (SHINE) is a 10-week health education program developed for 6th graders (n= 39), 7th graders (n= 43), and 8th graders (n= 23) that was implemented at a charter school consisting of primarily Somali adolescents, of which the majority are from economically disadvantaged backgrounds and are English as second language learners. The intervention consisted of 4 main components: 10 weekly 1-hour health lessons, weekly health behavior tracking, weekly exposure to career pathways, and two in-person college immersion experiences. Pre-intervention questionnaires were given to determine baseline health knowledge and behaviors. At the conclusion of the program, a similar post-intervention questionnaire was given to evaluate for improvement. Outcomes were measured within six core competencies (nutrition/exercise, mood/depression, interpersonal relationships, sleep, dental hygiene, and career development). Fact-based recall questions were scored 0 or 1. Questions evaluating engagement in health behaviors were scored between 0 and 1 on a linear scale. Scores were normalized to a 10-point scale, with higher point values indicating greater knowledge in that competency. T-test analysis was performed to calculate the difference of means pre- and post-intervention.

Results: At the conclusion of the program, significant improvement was seen in 6th graders' knowledge and behaviors in the areas of nutrition/education (0.70, p = 0.046), mood/depression (1.1, p = 0.061), and career development (1.2, p = 0.040). Additionally, improvement in the area of mood/depression was seen in the 8th graders (1.4, p = 0.041). No statistically significant improvement in any of the six competencies was observed in the 7th graders.

Conclusion: Health education programs play an important role in providing access to basic health education and promoting healthy lifestyle behaviors in communities. However, more research needs to be done to understand how best to cultivate healthy behaviors in this population. Future directions include developing improved population-specific teaching methods through better understanding of the targeted population.