Using grounded theory to develop culturally-based Hmong nutrition education curriculum

Prevention of unhealthy acculturation-related lifestyle changes in families, specifically diet and physical activity, is an urgent need. The Hmong, a refugee population from Southeast Asia, face challenges with assimilation, limited resources, low educational attainment and language isolation. A grounded theory model evolved in the development of a Hmong nutrition education curriculum for the California Expanded Food and Nutrition Education Program. The curriculum met grounded theory components through a sequence of using qualitative and quantitative data evaluation techniques. The model consists of four cycles, each with three drivers. 1) “Find:” literature to acquaint researchers to sociological uniqueness; ethnic leaders and partners; and ethnic extenders. This was accomplished through relationships in communities where trust between partners was well established. 2) “Discover, understand, and accept:” the linguistic and educational uniqueness of the population, their health beliefs and lifestyle values – specifically food and physical activity patterns. Focus groups provided researchers with an understanding of families' perceptions on the practical aspects of the messages. 3) “Adapt and develop resources:” curriculum and materials were designed for extender training. A key finding was the Hmong's ability to relate and learn from television; DVDs were designed to meet specific challenges. 4) “Re-discover and refine:” Provided researchers with population's interpretation and application of resources and the potential for health impacts. Process and quantitative evaluation conducted on two administrations of the curriculum in three CA Central Valley Counties documented and analyzed the development and actual implementation of the program. Strategies were assessed and evaluation instruments refined.