“ CLUES and the community health workers brought an understanding of how to work in the community and how to lead a campaign. I really want to highlight the quality of the community health workers. They keep on improving and improving.” Liliana M. Tobon-Gomez, M.D., M.P.H. Senior Health Promotion Specialist Hennepin County

An award-winning Minnesota nutrition program has proven to be an innovative and effective way to educate Latino families and communities about the importance of healthy nutrition in preventing chronic disease.

Developed by Hennepin County Public Health Promotion and Comunidades Latinas Unidas en Servicio (CLUES) in Minneapolis, Fiestas de Salud Latinas uses a unique method to deliver health education to Latino families and communities: home health parties, community events, and grocery store demonstrations presented with a Latino flair. Since its inception in 2007, thousands of residents have come away from these events with practical knowledge on the importance of eating at least five servings of fruit and vegetables per day and other disease prevention measures.

Hennepin County approached CLUES as a partner for the campaign because of the latters’ success in using community health workers to educate Latinos in Minnesota about tobacco prevention.

“This made CLUES an ideal partner for nutrition education,” said Liliana Tobon-Gomez, M.D., M.D.H., who guides the fiestas program for Hennepin County. “They already had an infrastructure of community health workers in the community.”

APRIL 2010

CLUES – Fiestas de Salud Latinas Nutrition Program

TAPP INTO SuccessStoryfromBlueCrossFundedOrganizations

Since five community health workers started educating Latino families and communities in 2007, it is estimated that more than 2,300 residents in the Latino community have participated in the program. The fiestas are supported by the Minnesota Food and Nutrition Network through the USDA Supplemental Nutrition Assistance Education Program.

To help assess the effectiveness of the program, fiesta participants are given pre- and post-event tests that measure changes in participant knowledge. The test results show that 62 percent of the adults had an increase in knowledge of better nutrition and its effect on chronic disease.

In recognition of this success the program was the recipient of the “2008 Achievement Award” from the National Association of Counties, and the “2008 Silver Award for Excellence in Public Health Communication” from the National Public Health Information Coalition.

How is the Fiestas de Salud Latinas Effective? Fiestas de Salud achieved its goals of educating Latinos in Minnesota about eating fruits and vegetables through community competent health education by holding educational events at local supermarkets, churches and nonprofits in the Latino community. An integral piece of this education program was to empower community members to be informed consumers.

Culturally Competent CurriculumA key challenge was to not only create a comprehensive program but one that was culturally appropriate for the population. Understanding that the first language of many of the community members was not English, the community health workers use visual aids in their educational approach. In addition, since many of the community members did not have health insurance, the community health workers discuss the importance of nutrition as a disease prevention tool.

The focus of the curriculum was to take fairly complex nutrition science and present it in an easily understood traditional format. For example, customarily Latinos do not use common methods of measurement such as cups or tablespoons, so when community health workers describe vegetable portion sizes to participants they indicate that one serving is the amount of food that fits into the palm of one hand.

Community health workers reported that sugary juice drinks are often heavily marketed to Latinos. In response, they developed education strategies to teach community members about the sugar content in “juice like products.” “There are many juice-like drinks which are heavily marketed to the Latino community. The marketing is deceptive, so we teach the difference between juice drinks and 100 percent juice. We only recommend 100 percent fruit juice and even that can be drank in small portions, like what would fit into a Dixie cup” said Program Assistant Lauren Haun.

Using Visuals“The populations we work with respond to things that are graphic and visual” said health promoter Gloria Liliana Rivera. Another key component to the program was the use of colors for fruits and vegetables to convey nutritional benefits. “The reason why we use colors is because talking about vitamins is too abstract,” remarked Rivera. The curriculum talks about fruits and vegetables that fall into five colors – green, red, yellow, purple, and white. Community health workers describe the health benefits of fruits and vegetables in each color scheme. For example, green foods are good for your bones while purple foods are good for memory. Additionally, the promoters gave out recipes highlighting foods from each color.

“ There are many juice-

like drinks which are

heavily marketed to the

Latino community. The

marketing is deceptive, so

we teach the difference

between juice drinks

and 100 percent juice. Lauren Haun

Program Assistant

”

AUGUST 2009 TAPP INTO SUCCESS STORY 2

Ensuring AccessAlong with nutrition education, the Community health workers worked to ensure access to fruits and vegetables. Their work with a local supermarket, whose stores are located in Latino neighborhoods, has resulted in the grocer coordinating their sales specials with the particular food color group the community health workers were highlighting that day. In addition, their efforts at this local supermarket have sparked interested from non-Spanish speakers who asked for recipe cards and nutrition information.

The program looked at the realities of low-income Latinos many of whom worked multiple jobs and had limited time to cook. In response to these barriers, the program coordinators adapted recipes that participants currently used and added more servings of fruits and vegetables. Community health workers also showed participants how to prepare vegetables ahead of time for quick meals. Another aspect of how the community health workers address food access is to adapt the curriculum based on seasons. During the summer, the Community health workers directed families to farmers markets with Latino vendors and affordable produce. In the winter, they educated families on the use of canned fruits and vegetables.

What Are the Keys to an Effective Health Education Program?Involve the Community in Developing the ProgramCommunity input was an integral part of creating the curriculum and collateral materials. The program started with the basic concept of “5 A Day the Color Way” created by Produce for Better Health, but the coordinators wanted the program to reflect the traditions and culture of the Latino community. To obtain community input several focus groups were held to determine how messages about eating fruits and vegetables should be framed. One concrete piece of feedback from the focus group was to simplify the health information. Rather than discussing vitamin and mineral content, messages about health benefits were convey in terms of how the particular fruit or vegetable would help a specific body function. Focus groups also urged the health department staff to use the community health worker and a peer education model. “We were not telling them; they were telling us,” said Dr. Tobon- Gomez. This also resulted in community members being recruited as models for the campaign materials. Because community members played a key role in creating the curriculum, they saw themselves reflected in the campaign.

Ensure You Have Community Competent Health WorkersAn important factor in the success of the program is the expertise and understanding of the community health workers about the community and culture they were working with. The community health workers are deeply involved in their communities; they have strong connections to community and religious institutions as well as families. “We don’t have any problems reaching Latino families. They invite us into their houses.” said Rivera. The programs outreach activities focused on families, reaching out to both parents and children. Many home visits occurred with multiple families because families often invited their neighbors to join the discussion. Rivera commented that families often requested to make copies of her education materials to share with their extend family and neighbors.

One aspect of the community culture these community health workers understood particularly well was the importance of a neighborhood comadres – a person (usually a woman) who talks to all of their neighbors. Rivera says that identifying comadres is the first step in reaching families and sharing information. Neighborhood comadres informally invite their extended networks to a Fiesta de Salud and thus extend the reach of the health promoter.

... comadres – a person

(usually a woman)

who talks to all of

their neighbors.

AUGUST 2009 TAPP INTO SUCCESS STORY 3

Continuously Adapt to Community NeedsThe ongoing system of feedback between the community health workers and Hennepin County’s Human Services and Public Health Department helped make this program a success. At the end of each program period, Dr. Tobon-Gomez convened the community health workers to review the curriculum and provide feedback on its effectiveness with the community. This feedback was used to refine the curriculum. Community health workers also give proactive feedback after each church event and home health party on the effectiveness of the program. “Every round we do this and the more feedback we get the program becomes exponentially better,” said Haun.

An enhancement to the program that came from this feedback process includes education about fruit juice. Community health workers consistently reported that families were unclear about the difference between “juice-like drinks” and real fruit juice. Community health workers also identified literacy challenges among the families they served which resulted in the curriculums numerous visual aids.

Next StepsThe Fiestas de Salud Latinas pilot project has proven to be a model health education program. It is based on a strong partnership between CLUES and Hennepin County, building on the community reach of CLUES with the institutional resources of Hennepin County Human Services and Public Health Department. The strength of the project is its ability to incorporate feedback from the community on the approach and message as well and having community health workers with strong connections to the Latino community.

The first part of the project targeted low-income Latinos in the neighborhoods that border Lake Street. As a result of the success of Fiestas de Salud Latinas and its increased visibility, people in other neighborhoods began asking for the program in their neighborhood. The program has now extended to the entire county, with as many as 25 fiestas planned for 2010. The coordinators are also in the process of developing curriculum which will focus on reducing the consumption of fats and added sugars.

Sample program materials from Fiestas de Salud Latinas are attached.

CLUES receives training and technical assistance through the Technical Assistance for Priority Populations to Implement a Norm Change on Tobacco (TAPP INTO) program. The TAPP INTO Program is a comprehensive community-competent technical assistance and training program that supports community organizations working with African, African American, Latino, LGBT, and Southeast Asians in Minnesota. The goal of the TAPP INTO program is to build the capacity of these priority population-serving organizations in Minnesota and their emerging coalitions to implement successful tobacco control programs and policies and eventually reduce tobacco prevalence, exposure to secondhand smoke, and other tobacco disparities. This work is supported by Blue Cross and Blue Shield of Minnesota (Blue Cross) as part of a health improvement initiative funded by tobacco settlement dollars that addresses root causes of preventable heart disease and cancer. Blue Cross’ prevention efforts with high priority populations include a commitment to build community capacity to work on health promotion efforts.

AUGUST 2009 TAPP INTO SUCCESS STORY 4

Preparación1. Enjuague con agua fría los frijoles rosados secos, lentejas, frijoles negros, guisantes amarillos, judias y frijoles de carete. Coloque los frijoles, lentejas y guisantes en un tazón grande, cubra con agua por arriba de la mezcla. Tape y deje reposar 8 horas, luego escurra.2. Combine la mezcla de frijoles secos, lentejas y guisantes, agua y jamón en una olla grande; deje hervir. Agregue las especies, cebolla, zanahorias, apio, tomates y salsa de tomate. Tape, reduzca el fuego y deje hervir a fuego lento durante 2 horas. Destape y cocine durante 1 hora.3. Deseche la hoja de laurel. Saque el jamón de la sopa. Remueva la carne del hueso; desmenuce la carne con 2 tenedores. Agregue la carne a la sopa.

Rinde 8 porciones. 2 tazas por porción.Tiempo de preparación: 20 minutos(sin incluir el remojo de los frijoles)Tiempo de cocción: 3 horas

Información nutricional por porciónCalorías 297, Carbohidratos 49 g, Proteína 22 g,Grasa Total 3 g, Grasa Saturada 1 g, Colesterol 13 mg,Sodio 334 mg, Fibra Dietética 14 g.

Ingredientes½ taza de cada uno de los siguientes: fríjol seco rosado, lentejas secas, fríjol negro seco, guisantes amarillos secos, judias secas, frijoles de carete secos8 tazas de agua1 pierna de jamón (aproximada-mente de ½ libra)1 cucharadita de cada uno de los siguientes: albahaca seca, romero seco, mejorana seca y chile rojo molido

½ cucharadita de sal y de pimienta negra molida1 hoja de laurel1 taza de cebolla picada½ taza de zanahorias picadas½ taza de apio picado2 tazas de tomates cortados 1 lata (8 onzas) de salsa de tomateAjo al gusto

RIQUÍSIMA SOPA DE FRÍJOL CON VERDURAS

Hennepin County Public Health Promotion(612) 348-5618

¡Adopta un Estilo de Vida Sano!

Como quieres vivir Tú Decides...

Haz Ejercicio Camina al menos 30 minutos al día o practica algún deporte.

Toma Líquidos Para un adulto se recomiendan 8 vasos de líquidos diarios. (agua, jugos, sopas)

Visita al Médico Debes solicitar un examen general al menos una vez al año aunque te sientas bien. Muchas enfermedades avanzan silenciosamente.

Disfruta una Dieta Balanceada

¡El cigarillo, el alcohol y las drogas son nocivos para tu salud!

Promotores de Salud

La obesidad puede causar:La obesidad puede causar: Diabetes

Enfermedad crónica que se caracteriza por el aumento de azúcar en la sangre.

La Diabetes puede ocasionar: ♦ Ceguera ♦ Insuficiencia renal y otras enfermedades de

los riñones ♦ Amputaciones de extremidades inferiores ♦ Enfermedades cardiovasculares ♦ Problemas en las encías y caída de los dientes

Tensión Alta Es el resultado de una mayor presión sobre las arterias ejercida por la sangre que circula por el cuerpo.

La tensión alta puede causar: ♦ Infarto del corazón y otras enfermedades

cardiovasculares ♦ Embolia ♦ Derrame cerebral y sus secuelas tales como

parálisis (hemiplejia)

Los valores normales de la

tensión arterial son 120/80

La Mala Nutrición Es el exceso o la falta de nutrientes necesarios para que el cuerpo realice bien sus funciones.

La mala nutrición pude causar:

♦ Depresión ♦ Irritabilidad ♦ Anemia ♦ Mareos ♦ Fatiga ♦ Caída de los dientes ♦ Caída del cabello ♦ Obesidad

Una alimentación balanceada te ayuda a prevenir estos problemas.

Las frutas y las verduras deben hacer parte de tu alimentación diaria.

Es importante que comas al menos 5 porciones de frutas y vegetales

diariamente.

(1 porción equivale a la cantidad de frutas o verduras que quepan en tu mano)

Evita comer: ♦ Comidas grasosas e irritantes ♦ Comidas rápidas ♦ Dulces ♦ Sodas ♦ Sal en exceso ♦ Harinas y postres en exceso

ROJOROJO

Corazón sano, próstata sana.

VERDEVERDE

Huesos y dientes sanos.

AMARILLO, NARANJAAMARILLO, NARANJA Buena visión, piel saludable, buena cicatrización.

MORADOMORADO

Buena memoria

BLANCOBLANCO Ayuda a controlar el colesterol y a prevenir las infecciones.

TODOS LOS COLORES Pueden ayudan a

controlar la hipertensión

arterial y a prevenir enfermedades del corazón,

diabetes y algunos tipos de cáncer.

Beneficio de las frutas y vegetales según su color