Interventions
Participants who were randomized to EWS or EWS + MTM were assigned to receive 3 individual EWS sessions and 24 group EWS sessions delivered by CHEs. The three individual sessions cover behavioral targets included eating no more than 1 small bowl of (brown) rice per meal, walking at least 30 min per day on 6 days per week, and getting 7–9 h of restful sleep per night. The curriculum addresses the influence of genocide and resilience on health behaviors. After completing individual EWS sessions, participants started 1-h EWS group sessions and were asked to attend over 12 months. Each began with group discussion of traditional Khmer concepts of health. Sessions were conversational and activity based, including relaxation, supervised exercise, and cooking components. Each session included SMART (specific, measurable, achievable, realistic, timely) goal setting. Sessions were held in community settings convenient to the participants (e.g., social service agencies, temples). A full description of interventionists, intervention sessions, and settings has been previously reported [Participants assigned to EWS + MTM attended group EWS sessions with participants in the EWS arm. In addition, they received at least 3 MTM sessions between baseline and post assessment. A booster MTM session was also scheduled between endpoint (12-month) and follow-up (15-month) assessments. MTM followed guidelines of the American Pharmacist Association [Participants who were assigned to SS were assessed for any social service needs including food or housing assistance, referral to a healthcare provider, tax preparation, or citizenship applications and CHEs/CHWs followed up to address the need. For equity, after they completed their follow-up assessment, participants randomized to SS received a single, abbreviated EWS session and results of their lab work, along with results to their healthcare provider.