Sapna NYC’s Health Portfolio
Sapna NYC started out as a mental health research project . Eight years later we are still delivering top class health programs. More than that, Sapna NYC has become a laboratory for developing innovative, scientific, community based health interventions that really work!
The goal of our health programs is to improve Health. To get there, though, we can’t just teach women in our programs facts about health. First of all, to understand why certain diseases and health problems become an issue in certain communities, you have to understand that disease isn’t just caused by germs or personal behaviors like diet—it’s caused by poverty, unhealthy environments, deprivation, stress, and social injustice. To make a real, lasting difference in addressing health problems in low income communities, science shows that you have to address the context and social world in which a person lives. That’s why all of our health programs are based on our Theory of Change, the Social Ecological Model.
Our innovative health programs have a proven record in improving health outcomes. To learn more, see below:
- Depression treatment – See ASHA below
- Diabetes prevention – See APPLE below
- Child health – CHALO Paper 1 and CHALO Paper 2 – See CHALO below
- Breast cancer screening – See SABHA below
“Activating People to Pursue Lifestyle change through Empowerment”
APPLE (“Activating People to Pursue Lifestyle change through Empowerment”) is a community participatory intervention that addresses obesity and physical activity. APPLE was designed for South Asians from Pakistan, India and Bangladesh. The APPLE program is an evidence based intervention developed with support from researchers at Albert Einstein College of Medicine. The primary goal of APPLE is to provide an effective weight control plan based on intensive, individual focused lifestyle changes. The long-term goal is to create self sustaining ‘communities of practice’ who will continue to support each other, improve their knowledge, and continue sharing their expertise with other community members.
APPLE participants learn about nutrition, exercise and weight loss though a multi phase learning process; evaluate the familial and social barriers to weight control, and design their own strategies for weight loss. Each participant is assigned one Bondhu/Saheli (“friend”) partner within the group. The pairs work together throughout the program, providing social and emotional support, weight loss goal setting, and troubleshooting support. In the final phase of the project, participants develop outreach projects that are designed to share knowledge with the larger community.
SAATHI (“South Asians Acting Together for Health Improvement“) is an extension of the APPLE project for community members identified as pre-diabetic. SAATHI is a lifestyle modification and diabetes prevention or maintenance intervention. Similar in most respects to APPLE, SAATHI is designed to address diabetes. It is conducted in primary care settings in our partner practices in Queens. Primary care providers collaborate in providing support and follow up to patients.
APPLE and SAATHI include 3 phases:
- Learning – gaining knowledge about healthy eating habits and benefits of regular exercise
- Practice – putting to use this knowledge in daily cooking; start walking as a form of exercise, with access to pedometers
- Outreach – sharing their knowledge and experience with other members of the community
Since inception in 2011, 79 women enrolled in APPLE/SAATHI from diverse sites: our South Asian immigrant community in the Bronx, Primary Care Practices in Queens and the Bait-ul-Zafar mosque in Hollis.
- APPLE & SAATHI Outcomes
- 68% retention rate
- Significant reduction in consumption of fried snacks/chips, soda and rice
- 5.8% reduction in BMI
- Increased physical activity
- Anecdotal reports of reduced improved health in family members
- Significant reduction in HgA1C for SAATHI participants
“Action to improve Self Help and empowerment through Asset building”
ASHA (“Action to improve Self Help and empowerment through Asset building”) is a community participatory research project designed to address mental and physical health, and enhance emotional well being among South Asian women in the Bronx. ASHA’s goal is to empower women by providing education, support, and assistance in building financial assets.
ASHA is a uniquely structured, 12-session program for 26 weeks designed to address depression among South Asian immigrant women using asset building as a tool in the treatment process. ASHA enhances psychological assets through psycho-education, skill building and cognitive behavioral strategies. To date, 65 women participated in the ASHA Program. The Program is highly effective in improving mental health, self-confidence and hope.
At present, 21 ASHA graduates have already successfully made asset purchases with their matched savings, pursuing their education and starting small businesses. Given this rate of success, Sapna NYC seeks to expand our successful program and enroll a new cohort of participants. We currently have a grant from the Van Ameringen Foundation to offer psychosocial support to 24 low-income women suffering from depression.
The Program – ASHA builds assets for low-income immigrant women on three levels: 1) psychological assets; 2) social assets; and 3) financial assets.
1) Psycho-Education: Patients learn to manage depressive cognitions such as self-criticism, defeatism and worries. Sapna NYC also teaches patients behavioral strategies for reducing symptoms of depression. Many women live highly inactive lives, isolated at home with only the television or small children for company. Participants learn the importance of increasing pleasurable activities and exercise.
2) Social Asset Building: A key precipitant of depression in the community is isolation. ASHA is designed to help women build lasting social connections that will persist beyond the end of the program period. The group itself also becomes a major source of support.
3) Financial Asset Building: Finally, ASHA helps women build financial assets using a matched savings strategy. Women are provided with financial literacy training and open bank accounts. For most, this is the first bank account they have ever had. Each woman saves a minimum of $5 per week. At the end of the program period, savings are matched. Participants have used their funds to pay for a micro enterprise incubator program, a food work license, a GED course, and an intensive English language program.
Among the forty ASHA graduates in 2013:
- Depression scores dropped by 50% on the standardized PQH-9 scale.
- Participants saved about $10/week, twice the national average for Individual Development Accounts.
- Program retention rate exceeded 80%.
- Participants reached over 1,000 community members to raise awareness about mental health and financial independence.
Participants have made investments with their IDA savings, including: the launch of a workers’ cooperative, home health aide training, food work licenses, college tuition, and English courses.
“South Asian Breast Health Awareness”
New South Asian immigrants are characterized by high levels of need, especially a lack of health insurance, financial problems, lack of English skills, and housing problems. A recent study of south Asian women immigrants over 40 found that 40% reported an income under $25,000, 54% had no health insurance; 29% had not received screening in the past two years, a third had no regular source of medical care, and nearly half reported low English proficiency.
The South Asian immigrant community faces many barriers to breast health. Lack of knowledge presents a major barrier to seeking services. Breast cancer is the second most common cancer in women living in South Asia, yet a 2006 survey of women age 40 and older living in Bangladesh showed that 9% had never heard of breast cancer, 26% had never heard of mammograms or breast self-exams. Cultural and religious restrictions present a major barrier to seeking and receiving breast health screenings. In some cases women’s gender roles discourage assertiveness, with the result that women are often unlikely to confront their physicians with direct questions or requests. A lack of awareness of disease prevention is also an issue. Among South Asian immigrants, as among many other groups, there is little awareness of the importance of disease prevention.
Finally, a lack of English language proficiency results in reluctance to seek services and difficulty navigating the complex health care institutions.
In addressing these barriers, Sapna has developed education and outreach strategies that are responsive to the community we serve and respectful of cultural differences. We have trained Community Health Workers— women from the local community—to deliver our programs, since they will understand the cultural sensitivities of the audience they reach. We use participatory methods in education programs, emphasizing the knowledge that the student brings, and the interactional and social nature of learning. We use Action Groups to deliver much of our program. The Action Group is a group of proactive community members who receive education and conduct outreach within their own community. The group then works together on an ‘action’ to address the problem. Our current experience shows that this approach is extremely effective in reaching insular, isolated South Asian women who are unlikely to be engaged in medical care. Moreover, they ensure that each person screened receives follow up services.
- Bring together Action Group members to share knowledge, offer education and training in outreach and cancer.
- Each Action Group member does one-to-one education of 4-5 women and gets them through screening, patient navigation and follow up.
- We empower our participants and enable them with tools for making annual mammograms a life choice.
- Currently SABHA is generously funded by a grant from Komen Greater NYC.
The CHALO! Project
Child Helath Action to Lower Obeisty and Oral health risk
South Asian children are at high risk for obesity, cardio vascular disease, and diabetes in adolescence and adult life, along with oral caries (tooth decay). Part of the problem is child feeding. South Asian mothers are big fans of bottle feeding. With the goal of making kids healthy and chubby, South Asian moms will put sweeteners and pureed foods into the bottle. And Moms tend to wean late—as old as three or even four years old.
The problem is that prolonged feeding, and putting anything in the bottle other than formula or water—leads to health problems including weight gain and tooth decay.
Along with Sapna staff, Dr. Alison Karasz carried out a pilot project in 2013 to help address this problem. Community health workers visited mothers in the home to help them improve child feeding and reduce risk of obesity and oral caries. A big focus was helping moms make a transition to cup and table feeding. Moms also were encouraged to take their kids to the dentist before age 2.
Our program was a resounding success! To read about it, click on these links:
- Reducing Oral Health Risks in South Asian Immigrant Children: A Pilot Study
- Preventing caries in young children of immigrant Bangladeshi families in New York: Perspectives of mothers and paediatricians
Now, in 2016, Alison has been awarded a multi-million dollar grant to scale up the CHALO project and address child feeding in the NY metropolitan region. Partners include Dr. Karen Bonuck at Albert Einstein , South Asian Total Health Initiative (SATHI) at Rutgers, and others.