"We worked together to change things about our lives": a longitudinal qualitative analysis exploring Hispanic/Latino and Somali immigrant health promoters' perspectives on a social network intervention to address cardiovascular disease disparities.

Background: Evidence-based health promotion programs are commonly assessed within research environments, yet there is a critical need to understand how to implement interventions across multiple settings, prioritizing populations who are underserved and under-resourced. A possible approach involves leveraging established social networks to enhance health outcomes. Within these networks, influential individuals, known as health promoters (HPs), play a key role in disseminating health information. The Rochester Healthy Community Partnership created a social network-based intervention called Healthy Immigrant Community (HIC), utilizing HPs to encourage healthy eating and physical activity to address cardiovascular disease outcomes among Hispanic/Latino and Somali immigrant populations. We conducted three focus groups pre-, mid-, and post intervention (nine groups total; n = 30) to understand HPs' motivations for participating, implementation barriers and facilitators they faced, and suggestions for improvement.

Methods: Using the National Institute on Minority Health and Health Disparities Research Framework and Public Health Critical Race Praxis, we conducted a longitudinal trajectory analysis to explore themes and changes over time.

Results: Participants reported that their motivations to be a HP in Healthy Immigrant Community were personal goals, such as health improvement and weight loss, as well as collective community benefits and personal gains like knowledge and leadership skills. Barriers included logistical challenges, navigating health-related differences between one's country of origin and the US, and structural issues such as racism, high costs (e.g., food), and absence of an affordable gym. Facilitators included strong community ties, peer-to-peer support, and culturally relevant approaches, with participants recommending additional resources, tailored programming, and reframing the program's focus on overall health rather than weight loss.

Conclusions: Our study highlighted a shift in HPs' motivations to participate in Healthy Immigrant Community from weight loss to holistic health promotion. The HPs' reflections on their experience showcase the transformative impact of culturally tailored, equity-focused interventions while emphasizing the need to address systemic barriers and incorporate community feedback for sustainable change.