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Soca Lozano S, Buro AW, Gonzalez-Videla K, Rodriguez C, Rancourt D, Gray HL, Bailey R, Redwine L, Stern M. Training Promotoras to Implement a Mindfulness-Based Healthy Lifestyle Program in Rural Communities. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:406-412. [PMID: 38520425 PMCID: PMC11162307 DOI: 10.1016/j.jneb.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
Partnering with promotoras to implement a healthy lifestyle intervention has proven efficacious in reaching community members whom they serve. However, there are no clearly defined guidelines for implementing promotora training, especially when it involves developing mindfulness skills in promotoras unfamiliar with this concept. This is a report about the facilitators and barriers to training promotoras to implement a mindfulness-enhanced healthy eating and physical activity intervention, ADAPT+, using the Train-the-Trainer model. Following this model, we laid the foundations for sustained implementation of ADAPT+ even after the training process. Future studies may examine how these guidelines help map promotora training in other mindfulness-related interventions.
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Affiliation(s)
- Sandra Soca Lozano
- Department of Educational and Psychological Studies, College of Education, University of South Florida, Tampa, FL
| | - Acadia W Buro
- College of Population Health, University of New Mexico, NM
| | - Karen Gonzalez-Videla
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | | | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, FL
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL
| | | | - Laura Redwine
- Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Tampa, FL
| | - Marilyn Stern
- College of Population Health, University of New Mexico, NM; Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL.
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Stern M, Rancourt D, Soca Lozano S, Buro AW, Gray HL, Rodriguez C, Bailey R, Redwine L. Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness. J Pediatr Psychol 2023; 48:666-675. [PMID: 37541829 PMCID: PMC10468101 DOI: 10.1093/jpepsy/jsad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. METHODS In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. RESULTS Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. CONCLUSION Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. CLINICAL TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov under identifier NCT04800432.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, USA
| | | | - Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, USA
| | | | | | - Laura Redwine
- Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, USA
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Redwine LS, Schwartz ER, Garland EL. Mindfulness Promotes Positive Health Behaviors by Enhancing Self-Regulation, Motivation, and Learning: Perspectives from Research and Clinical Care. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:847-850. [PMID: 36342808 PMCID: PMC9839340 DOI: 10.1089/jicm.2022.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Laura S. Redwine
- Osher Center for Integrative Health, Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - E. Robert Schwartz
- Osher Center for Integrative Health, Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, USA
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Foster BA, Weinstein K, Padilla T, Martinez C, Angeles-Ramos D. Growing Healthy Together: A Randomized Clinical Trial Using Parent Mentors for Early Childhood Obesity in Low-Income, Latino Families. Child Obes 2022; 18:168-177. [PMID: 34613828 PMCID: PMC8982108 DOI: 10.1089/chi.2021.0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Parent mentors are a potential community-based mechanism for delivering behavioral interventions. For communities at a higher risk of obesity and challenges with access to care, such as migrant and seasonal farm workers, this may be an effective intervention for obesity. This study examined the effect of parent mentors on weight outcomes. Methods: This randomized clinical trial assigned parents of 2- to 5 year-old children enrolled in Head Start 1:1:1 to control, a parent mentor teaching We Can!, or a parent mentor teaching an intervention derived from positive deviance methods. The parent mentor arms were designed to have weekly interactions and monthly community meetings over 6 months. The primary outcome was change in adiposity, as measured by body mass indices. Results: We randomized 188 parents, and 155 completed the 6-month visit. Most parents, 107 (58%), had less than a high school education, and 170 (90%) reported Latino ethnicity. In the intention-to-treat analysis, no difference between the groups was observed for change in percent distance from the median or BMI z-score. The median number of interactions was 14 (IQR 10-20) over 6 months for those who did engage, though 24 of 118 (20%) had no interaction. Those with no interactions in We Can! had a mean increase in change from median of 6.7 [standard deviation (SD) = 8.2]; those with higher participation experienced a 0.4 (SD = 9.2) change, p = 0.04. Conclusions: Parent mentors were not effective in changing the adiposity indices in this study overall, with some evidence of efficacy after accounting for participation. Clinicaltrials.gov registration number: NCT03330743.
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Affiliation(s)
- Byron A. Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
- Address correspondence to: Byron A. Foster, MD, MPH, Department of Pediatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CDRC-P, Portland, OR 97239, USA
| | - Kelsey Weinstein
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Thalia Padilla
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Cynthia Martinez
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Diana Angeles-Ramos
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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Stern M, Gray HL, Ruble K, Soca Lozano S, Albizu-Jacob A, Williams JM, Godder K, Fuemmeler B, Mazzeo S. A cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity: Rationale and study protocol of NOURISH-T. Contemp Clin Trials 2021; 102:106296. [PMID: 33515782 DOI: 10.1016/j.cct.2021.106296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Approximately 40-50% of pediatric cancer survivors (PCS) are overweight or obese; increasing their risk for metabolic syndrome and other negative long-term physical health complications. Using our successful pilot trial testing the preliminary feasibility and efficacy of NOURISH for Healthy Transitions (NOURISH-T), we refined our intervention, now NOURISH-T+, and will implement these refinements in this larger, multi-site randomized control trial. Parents of PCS with overweight/obesity (BMI ≥ 85th%ile), age 5-12, ≥6 months off treatment are randomly assigned to the NOURISH-T+ intervention or Enhanced Usual Care (EUC) comparison. Parents in NOURISH-T+ will participate in a 6-session, manualized intervention, with an additional dietician session and 2 PCS sessions, as well as post-intervention booster sessions. EUC consists of a one-time informational session, nationally available brochures and follow-up check-ins. Both study conditions will be conducted remotely via a videoconferencing platform. Parents and PCS will be assessed on anthropometric measures, physical activity (PA) and dietary behaviors at baseline, 3-, 6-, and 12-months post-intervention. We will enroll a diverse group of 260 parents/PCS dyads from four pediatric oncology clinics with the aim of evaluating the efficacy of our intervention across diverse pediatric oncology clinics. Our main aim is to compare the impact of NOURISH-T+ with EUC on PCS BMI z-score. Secondary aims are to compare intervention impact on PCS PA and eating behaviors and parent BMI and behaviors as well as to explore potential moderators of the intervention. Our longer-term goal is to establish a framework for future translation and dissemination of NOURISH-T+.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Kathy Ruble
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Sandra Soca Lozano
- College of Education, University of South Florida, Tampa, FL, United States of America
| | - Alexandra Albizu-Jacob
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Jeffrey M Williams
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Kamar Godder
- Nicklaus Children's Hospital, Miami, FL, United States of America
| | - Bernard Fuemmeler
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America
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Stern M, Redwine L, Soca Lozano S, Rancourt D, Rodriguez C, Gray HL, Lock S, Bailey R. Design and rationale for ADAPT+: Optimizing an intervention to promote healthy behaviors in rural, Latino youth with obesity and their parents, using mindfulness strategies. Contemp Clin Trials 2020; 101:106243. [PMID: 33307226 DOI: 10.1016/j.cct.2020.106243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Latino youth living in rural areas represent an ethnic and geographical minority population at increased risk for obesity and obesity-related complications. We previously modified our child obesity intervention to be a multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to better meet the needs of our target population, rural Latino youth with obesity (8-12 years old) and their parents. Recognizing the role of parent stress on obesity, the main goal of this study is to 1) further refine and optimize the original ADAPT multi-family behavioral obesity intervention protocol to include mindfulness parent stress reduction strategies (now called ADAPT+) and then 2) assess the feasibility of ADAPT+ implementation via a small randomized control trial (RCT) with rural Latino families. Two aims guide the study. For Aim 1 we conduct a series of focus groups with stakeholders and parents, and then conduct a one-arm trial with both parents and their children to obtain feedback for further refining each of our eight integrated ADAPT+ sessions. Aim 2 tests the acceptability and feasibility of our intervention with multi-family groups of Latinos in two rural communities over time (pre-intervention, post-intervention, 3-month follow-up) in a randomized pilot trial (ADAPT+ vs. Enhanced Usual Care [EUC] comparison). This study is intended to set the groundwork for a larger clinical trial to test ADAPT+'s efficacy to improve rural Latino families' eating and physical activity behaviors.
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Affiliation(s)
- Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America.
| | - Laura Redwine
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States of America
| | - Sandra Soca Lozano
- College of Education, University of South Florida, Tampa, FL, United States of America
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, FL, United States of America
| | - Carmen Rodriguez
- College of Nursing, University of South Florida, Tampa, FL, United States of America
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Sharen Lock
- New Tampa Yoga, Tampa, FL, United States of America
| | - Rocio Bailey
- Hispanic Services Council, Tampa, FL, United States of America
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