Reaching Immigrants through Community Empowerment (RICE)

Project RICE (Reaching Immigrants through Community Empowerment) is a five-year community-driven initiative to promote diabetes prevention among Korean American and South Asian American immigrants in New York City using a community health worker (CHW) model approach. The project is funded by the Centers for Disease Control and Prevention (CDC) and is the core research project of the New York University Health Promotion and Prevention Research Center (PRC). It is conducted in partnership with local health providers and community and faith-based organizations.

The purpose of Project RICE is to improve knowledge, increase preventive health behaviors, and increase access to health care services among Korean and South Asian Americans who are at risk for diabetes. In particular, this project aims:

  • To utilize community based participatory research (CBPR) methods to expand upon an existing campus-community partnership to develop and implement a CHW program among Korean and South Asian Americans that promotes diabetes prevention;
  • To gather descriptive information on access to care, health behaviors, and beliefs as related to diabetes prevention among these two populations in NYC; and
  • To develop, implement, and assess the efficacy of a CHW intervention to promote diabetes prevention and access to care among NYC Koreans and South Asians.

Asian Americans experience a disproportionate burden of diabetes compared to other racial and ethnic groups, and new and innovative ways to address health promotion and disease prevention are critical to reducing health disparities. Project RICE is the first intervention to test the efficacy of a CHW program to prevent diabetes in the Korean and South Asian populations. CHWs serve as frontline health workers who are indigenous to the community in which they work— ethnically, linguistically, socioeconomically, and experientially. CHWs’ understanding of community norms, attitudes, values and strengths is valuable given the growth of minority and underserved populations whom health care providers have difficulty reaching.

Study Design

Project RICE consists of two phases. A descriptive study (completed in 2010) informed the design of the CHW pilot intervention (completed in 2012) and full intervention (launched Summer 2012).

1. Descriptive Study

Surveys, health screenings, and focus groups were conducted to collect qualitative and quantitative data. Diabetes resources and needs assessment surveys were administered in Korean and South Asian communities at community health fairs in order to characterize community members’ general health needs, access to services, life style behaviors, and perceptions of disease as related to diabetes prevention and health promotion. Participants also took part in a health screening to measure fasting blood glucose, cholesterol, body mass index, and blood pressure, yielding clinical data on prevalence of diabetes risk factors among Korean and South Asian Americans in NYC.

Focus groups led by trained CHWs were conducted with Korean and South Asian immigrants (1 male and 1 female group per community). These provided particular insight into the health behavior practices of recently immigrated Korean and South Asian individuals that may have an impact on health promotion and diabetes prevention. Focus groups also informed our ability to adapt existing measures and educational curricula so that they are culturally relevant and appropriate for use in the Korean and South Asian American communities in NYC.

Brief reports on the results of the descriptive study in the Korean and South Asian communities can be found here.

2. CHW Intervention

This study uses a randomized controlled treatment design to test the effectiveness of a CHW intervention to promote diabetes prevention among individuals at risk for diabetes in the Korean and South Asian communities in NYC. Participants are recruited through outreach efforts by our community partners and CHWs in Queens and Manhattan. Eligible participants will be: (a) Korean or South Asian immigrants; (b) identified as at risk by a diabetes risk assessment; (c) between 18-75 years of age; and (d) willing to be randomized to either treatment or control groups.

Project RICE CHWs have undergone an extensive training and are based at community partner sites where they meet with eligible participants during 6 two-hour group sessions and follow up with weekly telephone calls. They provide social support, as well as informational/educational materials and instruction on diabetes prevention and health promotion. They also link and negotiate participants’ access to a primary care physician. CHWs conduct baseline, 3-month, and 6-month semi-structured interviews with participants to assess predisposing and reinforcing risk factors for diabetes, diabetes knowledge and health behaviors, and primary client outcomes to determine the effectiveness of the CHW intervention.

We hypothesize that individuals in the case group, when compared to the control group, will experience:
H1: Greater reductions in weight, BMI, and hip-to-waist ratio measurements
H2: Improved access to and utilization of healthcare services
H3: Greater knowledge and improved changes in dietary and physical activity

Data will be analyzed to evaluate the CHW intervention’s efficacy in health promotion and diabetes prevention in the Asian American community, as well as to inform the understanding of the contextual factors related to the intervention. If the CHW intervention is found to be efficacious, the RICE Coalition will make recommendations for the sustainable development of CHW interventions within community-based settings that serve other Asian American communities across NYC.

For more information on Project RICE, please contact Jennifer Zanowiak, Research Coordinator, at 212-263-0485, or jennifer.zanowiak@nyumc.org.