1
|
Santiago-Torres M, Contento I, Koch P, Tsai WY, Brickman AM, Gaffney AO, Thomson CA, Crane TE, Dominguez N, Sepulveda J, Marín-Chollom AM, Paul R, Shi Z, Ulanday KT, Hale C, Hershman D, Greenlee H. ¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods. Contemp Clin Trials 2021; 110:106524. [PMID: 34365016 PMCID: PMC8595705 DOI: 10.1016/j.cct.2021.106524] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors. METHODS Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw. RESULTS Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled. CONCLUSIONS We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers. TRIAL REGISTRATION ClinicalTrials.gov, NCT02780271, registered May 2016.
Collapse
Affiliation(s)
- Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Isobel Contento
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Pamela Koch
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | | | - Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, Connecticut, CT, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel Paul
- Program in Nutrition, Teachers College, Columbia University, New York, NY, USA; Rachel Paul Nutrition LLC, New York, NY, USA
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christiane Hale
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dawn Hershman
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| |
Collapse
|
2
|
Wang G, Wang Y, Gai X. A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment. Front Psychol 2021; 12:565202. [PMID: 34054628 PMCID: PMC8149892 DOI: 10.3389/fpsyg.2021.565202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Mental contrasting with implementation intentions (MCII) is a self-regulation strategy that enhances goal attainment. This meta-analysis evaluated the efficacy of MCII for goal attainment and explored potential moderators. A total of 21 empirical studies with 24 independent effect sizes (15,907 participants) were included in the analysis. Results showed that MCII to be effective for goal attainment with a small to medium effect size (g = 0.336). The effect was mainly moderated by intervention style. Specifically, studies with interventions based on interactions between participants and experimenters (g = 0.465) had stronger effects than studies with interventions based on interactions between participants and documents (g = 0.277). The results revealed that MCII is a brief and effective strategy for goal attainment with a small to moderate effect; however, because of some publication bias, the actual effect sizes may be smaller. Due to small number of studies in this meta-analysis, additional studies are needed to determine the role of moderator variables.
Collapse
Affiliation(s)
- Guoxia Wang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Yi Wang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Xiaosong Gai
- School of Psychology, Northeast Normal University, Changchun, China
| |
Collapse
|
3
|
Pintor JK, Alberto CK, Arnold KT, Bandara S, Baum LM, Fowler EF, Gollust SE, Niederdeppe J, Barry CL. Targeting of Enrollment Assistance Resources in Health Insurance Television Advertising: A Comparison of Spanish- Vs. English-Language Ads. JOURNAL OF HEALTH COMMUNICATION 2020; 25:605-612. [PMID: 33317426 PMCID: PMC7905836 DOI: 10.1080/10810730.2020.1818150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Latinx adults, especially immigrants, face higher uninsurance and lower awareness of the Affordable Care Act's (ACA) provisions and resources compared to other racial/ethnic groups. Television advertising of ACA health plans has directed many consumers to application assistance and enrollment, but little is known about how ads targeted Latinx consumers. We used Kantar Media/CMAG data from the Wesleyan Media Project to assess Spanish- vs. English-language ad targeting strategies and to assess which enrollment assistance resources (in person/telephone vs. online) were emphasized across three Open Enrollment Periods (OEP) (2013-14, 2014-15, 2015-16). We examined differences in advertisement sponsorship and volume of Spanish- versus English-language ads across the three OEPs. State-based Marketplaces sponsored 47% of Spanish-language airings; insurance companies sponsored 55% of English-language airings. The proportion of Spanish-language airings increased over time (8.8% in OEP1, 11.1% in OEP2, 12.0% in OEP3, p <.001). Spanish-language airings had 49% lower (95%CI: 0.50,0.53) and 2.20 times higher odds (95%CI: 2.17,2.24) of mentioning online and telephone/in-person enrollment assistance resources, respectively. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings, these mentions increased significantly in Spanish-language airings. Future research should examine the impact of the drastic federal cuts to ACA outreach and marketing.
Collapse
Affiliation(s)
- Jessie Kemmick Pintor
- Department of Health Management & Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Cinthya K. Alberto
- Department of Health Management & Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Kimberly T. Arnold
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA
| | - Sachini Bandara
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Laura M. Baum
- Wesleyan Media Project, Wesleyan University, Middletown, CT
| | | | - Sarah E. Gollust
- Department of Health Policy & Management, University of Minnesota, Minneapolis, MN
| | | | - Colleen L. Barry
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
4
|
Starkweather C, Guarino A, Bennion N, Cottam M, McGhie J, Dearden KA, Santika O, Jusril H, Hall C, Crookston BT, Linehan M, Torres S, Bennett C, West JH. An interpersonal nutrition campaign and maternal knowledge and childhood feeding practices: a case study from mothers in rural Indonesia. ACTA ACUST UNITED AC 2020; 78:62. [PMID: 32670574 PMCID: PMC7346385 DOI: 10.1186/s13690-020-00444-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022]
Abstract
Background The purpose of this study was to examine the extent to which a national nutrition communication campaign (NNCC) intervention providing interpersonal communication (IPC) was associated with improved knowledge and behaviors related to feeding practices among mothers with children under two years of age in rural Indonesia. Methods Data came from a follow-up, cross-sectional survey of 1734 mothers. Key outcomes of interest were minimum meal frequency, minimum dietary diversity and minimum acceptable diet, as defined by the World Health Organization. Associations between exposure to the NNCC intervention and infant and young child feeding (IYCF) knowledge and behaviors were analyzed using adjusted linear and logistic regression, controlling for age, education, and income. Results A total of 525 mothers reported exposure to IPC interventions (30.3%). Participation in IPC was associated with increased knowledge of feeding practices (p < .0001). Separately, knowledge of feeding practices was related to achieving recommended behavioral practices of minimum meal frequency (p = 0.019), dietary diversity (p = 0.013), adequate diet (p < .001). Conclusion These findings underscore the value of increasing maternal knowledge of IYCF practices through IPC interventions as a way to improve behavioral practices and address stunting in rural Indonesia.
Collapse
Affiliation(s)
- Cecily Starkweather
- Department of Public Health, Master of Public Health Program, Brigham Young University, Provo, UT USA
| | - Ayla Guarino
- Department of Public Health, Master of Public Health Program, Brigham Young University, Provo, UT USA
| | - Natalie Bennion
- Department of Public Health, Master of Public Health Program, Brigham Young University, Provo, UT USA
| | - Malynne Cottam
- Department of Public Health, Master of Public Health Program, Brigham Young University, Provo, UT USA
| | - Josie McGhie
- Department of Public Health, Master of Public Health Program, Brigham Young University, Provo, UT USA
| | | | | | - Hafizah Jusril
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Cougar Hall
- Department of Public Health, Brigham Young University, 2139 LSB, Provo, UT 84602 USA
| | - Benjamin T Crookston
- Department of Public Health, Brigham Young University, 2139 LSB, Provo, UT 84602 USA
| | | | | | - Cudjoe Bennett
- Global Health Support Initiative III, Social Solutions Inc, Rockville, USA
| | - Joshua H West
- Department of Public Health, Brigham Young University, 2139 LSB, Provo, UT 84602 USA
| |
Collapse
|
5
|
Mirza M, Magaña S, Stoffel A, Xu Y, Kim Y. Piloting a Family-Centered Intervention to Promote Participation Among Latino Children With Autism Spectrum Disorder: A Comparison of Two Delivery Modes. ACTA ACUST UNITED AC 2020. [DOI: 10.3928/24761222-20191018-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
6
|
Gunn CM, Fitzpatrick A, Waugh S, Carrera M, Kressin NR, Paasche-Orlow MK, Battaglia TA. A Qualitative Study of Spanish-Speakers' Experience with Dense Breast Notifications in a Massachusetts Safety-Net Hospital. J Gen Intern Med 2019; 34:198-205. [PMID: 30350031 PMCID: PMC6374252 DOI: 10.1007/s11606-018-4709-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Legislation requiring mammography facilities to notify women if they have dense breast tissue found on mammography has been enacted in 34 US states. The impact of dense breast notifications (DBNs) on women with limited English proficiency (LEP) is unknown. OBJECTIVE This study sought to understand Spanish-speaking women's experience receiving DBNs in a Massachusetts safety-net hospital. DESIGN Eligible women completed one audio-recorded, semi-structured interview via telephone with a native Spanish-speaking research assistant trained in qualitative methods. Interviews were professionally transcribed verbatim and translated. The translation was verified by a third reviewer to ensure fidelity with audio recordings. PARTICIPANTS Nineteen Spanish-speaking women ages 40-74 who received mammography with a normal result and recalled receiving a DBN. APPROACH Using the verified English transcripts, we conducted a content analysis to identify women's perceptions and actions related to receiving the notification. A structured codebook was developed. Transcripts were independently coded and assessed for agreement with a modification of Cohen's kappa. Content codes were grouped to build themes related to women's perceptions and actions after receiving a DBN. KEY RESULTS Nineteen Spanish-speaking women completed interviews. Nine reported not receiving the notification in their native language. Four key themes emerged: (1) The novelty of breast density contributed to notification-induced confusion; (2) women misinterpreted key messages in the notification; (3) varied actions were taken to seek further information; and (4) women held unrealized expectations and preferences for follow-up. CONCLUSIONS Not having previous knowledge of breast density and receiving notifications in English contributed to confusion about its meaning and inaccurate interpretations of key messages by Spanish speakers. Tools that promote understanding should be leveraged in seeking equity in risk-based breast cancer screening for women with dense breasts.
Collapse
Affiliation(s)
- Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA. .,Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA.
| | - Amy Fitzpatrick
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Sarah Waugh
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Michelle Carrera
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| |
Collapse
|
7
|
Taverno Ross SE, Macia L, Documét PI, Escribano C, Kazemi Naderi T, Smith-Tapia I. Latino Parents' Perceptions of Physical Activity and Healthy Eating: At the Intersection of Culture, Family, and Health. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:968-976. [PMID: 29954715 PMCID: PMC6230483 DOI: 10.1016/j.jneb.2017.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore Latino parents' perspectives on healthy living and identify strategies to incorporate in a future child obesity intervention. DESIGN Descriptive, qualitative study. SETTING Participants were recruited from an emerging Latino community (area with low [ < 5%] yet growing concentrations of Latinos) in Allegheny County, PA. PARTICIPANTS Thirty-two parents of preschool children participated in 5 Spanish-language focus groups. PHENOMENON OF INTEREST Parents' perceptions of a healthy lifestyle (ie, physical activity and nutrition). ANALYSIS Data were analyzed using the constant comparison method to identify salient categories, themes, and patterns. RESULTS Three overarching themes were identified: (1) Healthy Living: Beyond One's Control; (2) Estamos Acostumbrados [We Are Used to a Certain Lifestyle]; and (3) Latin American and US Culture Conflict. In general, parents perceived maintaining a healthy lifestyle to require enormous effort and that change was difficult given a lack of knowledge and control. CONCLUSIONS AND IMPLICATIONS Key intervention approaches with this population may include a focus on the family environment. Increasing knowledge, building self-efficacy, and modeling behavior through family recipe preparation and physical activity breaks may be necessary, as well as an emphasis on and orientation to community resources to support behavior change and physical activity and healthy eating habits.
Collapse
Affiliation(s)
- Sharon E Taverno Ross
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.
| | - Laura Macia
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Patricia I Documét
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | | | | | | |
Collapse
|
8
|
Garcia DS. A review of healthy weight behavior maintenance in Hispanic women. Health Care Women Int 2018; 40:407-432. [PMID: 29308977 DOI: 10.1080/07399332.2017.1421197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Healthy weight behavior maintenance is key to prevent overweight and obesity in Hispanic/Latino women, particularly for those who are more likely to be sedentary. In this paper, I review the intervention components used by various researchers for successful healthy weight behavior maintenance for Hispanic women. Randomized and experimental studies were located (N = 9) through computer and manual searches in identified articles dated between 1992 and 2015. The methodological characteristics and components of the intervention studies were analyzed systematically. Maintenance of behavior was determined by the statistical significant behavior change and by the effective magnitude of the intervention effect report, favoring the experimental groups in the follow-up periods. Intervention components supporting Hispanic women's weight-related behavior changes and maintenance included interpersonal contact, intervention duration, and the use of cultural motivation and social support strategies. Seven studies were found to be successful in maintaining behavior change, although their retention rates at follow-up completion had either wide-ranging variations or were not specified. The findings are discussed, and recommendations are made so future efforts may successfully employ weight-related intervention strategies for behavior maintenance in Hispanic women.
Collapse
Affiliation(s)
- Daisy S Garcia
- a Nursing Faculty, Seattle University , Seattle , Washington , USA
| |
Collapse
|
9
|
Malcarney MB, Pittman P, Quigley L, Horton K, Seiler N. The Changing Roles of Community Health Workers. Health Serv Res 2017; 52 Suppl 1:360-382. [PMID: 28127766 DOI: 10.1111/1475-6773.12657] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To examine what different types of employers value in hiring community health workers (CHWs) and determine what new competencies CHWs might need to meet workforce demands in the context of an evolving payment landscape and substantial literature suggesting that CHWs are uniquely qualified to address health disparities. STUDY DESIGN We used a multimethod approach, including a literature review, development of a database of 76 programs, interviews with 24 key informants, and a qualitative comparison of major CHW competency lists. PRINCIPAL FINDINGS We find a shift in CHW employment settings from community-based organizations to hospitals/health systems. Providers that hire CHWs directly, as opposed to partnering with community organizations, report that they value education and training more highly than traditional characteristics, such as peer status. We find substantial similarities across competency lists, but a gap in competencies that relate to CHWs' ability to integrate into health systems while maintaining their unique identity. CONCLUSIONS As CHW integration into health care organizations advances, and as states move forward with CHW certification efforts, it is important to develop new competencies that relate to CHW-health system integration. Chief among them is the ability to explain and defend the CHW's unique occupational identity.
Collapse
Affiliation(s)
- Mary-Beth Malcarney
- Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Patricia Pittman
- Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Leo Quigley
- Trachtenburg School of Public Policy and Administration, The George Washington University, Washington, DC
| | - Katherine Horton
- Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Naomi Seiler
- Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| |
Collapse
|
10
|
Mosdøl A, Lidal IB, Straumann GH, Vist GE. Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database Syst Rev 2017; 2:CD011683. [PMID: 28211056 PMCID: PMC6464363 DOI: 10.1002/14651858.cd011683.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population. OBJECTIVES To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language. SELECTION CRITERIA We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. MAIN RESULTS Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse. AUTHORS' CONCLUSIONS The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.
Collapse
Affiliation(s)
- Annhild Mosdøl
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Ingeborg B Lidal
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
- Sunnaas Rehabilitation HospitalTRS National Resource Centre for Rare DisordersNesoddtangenNorway1450
| | - Gyri H Straumann
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
| | | |
Collapse
|
11
|
Delaney CL, Barrios P, Lozada C, Soto-Balbuena K, Martin-Biggers J, Byrd-Bredbenner C. Applying Common Latino Magazine Cover Line Themes to Health Communications. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986316660373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to describe strategies used in magazine cover lines to capture the attention of Latino consumers. A content analysis of cover lines ( n = 581) from six top-selling Latino women’s and parenting magazines ( n = 217 issues) sold in the United States identified 12 common themes: great/inspiring, beauty/health, bad/negative, love/passion, family/protective, strength/power, daring, informative/how-to, newness/uniqueness, improve/organize, happiness/fun, and easy/simple, with the first seven being unique to Latino-targeted magazines. Theses unique themes may be related to certain Latino cultural constructs, such as familismo, machismo, and respeto. Cover lines for nutrition education information mini-magazines were written using the strategies identified in the content analysis, then cognitive tested with 112 Spanish-speaking Latino parents. Parents felt the cover lines matched the guide content, were attention grabbing and catchy, and would motivate parents to read the mini-magazine. Findings can assist health communicators in creating brief Latino-targeted messages that are culturally responsive and capture reader interest.
Collapse
|
12
|
Sokol R, Fisher E. Peer Support for the Hardly Reached: A Systematic Review. Am J Public Health 2016; 106:e1-8. [PMID: 27196645 PMCID: PMC4984766 DOI: 10.2105/ajph.2016.303180] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Health disparities are aggravated when prevention and care initiatives fail to reach those they are intended to help. Groups can be classified as hardly reached according to a variety of circumstances that fall into 3 domains: individual (e.g., psychological factors), demographic (e.g., socioeconomic status), and cultural-environmental (e.g., social network). Several reports have indicated that peer support is an effective means of reaching hardly reached individuals. However, no review has explored peer support effectiveness in relation to the circumstances associated with being hardly reached or across diverse health problems. OBJECTIVES To conduct a systematic review assessing the reach and effectiveness of peer support among hardly reached individuals, as well as peer support strategies used. SEARCH METHODS Three systematic searches conducted in PubMed identified studies that evaluated peer support programs among hardly reached individuals. In aggregate, the searches covered articles published from 2000 to 2015. SELECTION CRITERIA Eligible interventions provided ongoing support for complex health behaviors, including prioritization of hardly reached populations, assistance in applying behavior change plans, and social-emotional support directed toward disease management or quality of life. Studies were excluded if they addressed temporally isolated behaviors, were limited to protocol group classes, included peer support as the dependent variable, did not include statistical tests of significance, or incorporated comparison conditions that provided appreciable social support. DATA COLLECTION AND ANALYSIS We abstracted data regarding the primary health topic, categorizations of hardly reached groups, program reach, outcomes, and strategies employed. We conducted a 2-sample t test to determine whether reported strategies were related to reach. RESULTS Forty-seven studies met our inclusion criteria, and these studies represented each of the 3 domains of circumstances assessed (individual, demographic, and cultural-environmental). Interventions addressed 8 health areas, most commonly maternal and child health (25.5%), diabetes (17.0%), and other chronic diseases (14.9%). Thirty-six studies (76.6%) assessed program reach, which ranged from 24% to 79% of the study population. Forty-four studies (94%) reported significant changes favoring peer support. Eleven strategies emerged for engaging and retaining hardly reached individuals. Among them, programs that reported a strategy of trust and respect had higher participant retention (82.8%) than did programs not reporting such a strategy (48.1%; P = .003). In 5 of the 6 studies examining moderators of the effects of peer support, peer support benefits were greater among individuals characterized by disadvantage (e.g., low health literacy). CONCLUSIONS Peer support is a broad and robust strategy for reaching groups that health services too often fail to engage. The wide range of audiences and health concerns among which peer support is successful suggests that a basis for its success may be its flexible response to different contexts, including the intended audience, health problems, and setting. PUBLIC HEALTH IMPLICATIONS The general benefits of peer support and findings suggesting that it may be more effective among those at heightened disadvantage indicate that peer support should be considered in programs intended to reach and benefit those too often hardly reached. Because engendering trust and respect was significantly associated with participant retention, programs should emphasize this strategy.
Collapse
Affiliation(s)
- Rebeccah Sokol
- All of the authors are with the Department of Health Behavior, University of North Carolina at Chapel Hill
| | - Edwin Fisher
- All of the authors are with the Department of Health Behavior, University of North Carolina at Chapel Hill
| |
Collapse
|
13
|
Viramontes O, Swendeman D, Moreno G. Efficacy of Behavioral Interventions on Biological Outcomes for Cardiovascular Disease Risk Reduction among Latinos: a Review of the Literature. J Racial Ethn Health Disparities 2016; 4:418-424. [PMID: 27287276 DOI: 10.1007/s40615-016-0242-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among Latinos. Designing and delivering culturally appropriate interventions are critical for modifying behavioral and nutritional behavior among Latinos and preventing CVD. OBJECTIVE This literature review provides information on evidence-based behavioral intervention strategies developed for and tested with at-risk Latinos, which reported impacts on biological outcomes. METHODS A literature search was performed in PubMed that identified 110 randomized controlled trials of behavioral interventions for CVD risk reduction with at-risk Latinos (≥1 CVD risk factor, samples >30 % Latino), four of which met the inclusion criteria of reporting biological outcomes (BP, cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and body mass index (BMI)). RESULTS All the studies used promotoras (Hispanic/Latino community member with training that provides basic health education in the community without being a professional healthcare worker) to deliver culturally appropriate interventions that combined nutritional and physical activity classes, walking routes, and/or support groups. One study reported statistically significant reductions in systolic blood pressure and an increase in physical activity. One study reported reductions in cholesterol levels compared to the control group. Two studies did not have significant intervention effects. Most studies demonstrated no significant changes in LDL, HDL, or BMI. Methodological limitations include issues related to sample sizes, study durations, and analytic methods. CONCLUSION Few studies met the inclusion criteria, but this review provides some evidence that culturally appropriate interventions such as using promotoras, bilingual materials/classes, and appropriate cultural diet and exercise modifications provide potentially efficacious strategies for cardiovascular risk improvement among Latinos.
Collapse
Affiliation(s)
- Omar Viramontes
- David Geffen School of Medicine of UCLA, 1624 Camden Ave. #8, Los Angeles, CA, 90025, USA.
| | - Dallas Swendeman
- David Geffen School of Medicine of UCLA, 1624 Camden Ave. #8, Los Angeles, CA, 90025, USA
| | - Gerardo Moreno
- David Geffen School of Medicine of UCLA, 1624 Camden Ave. #8, Los Angeles, CA, 90025, USA.,UCLA Department of Family Medicine, David Geffen School of Medicine of UCLA, Los Angeles, CA, USA
| |
Collapse
|
14
|
López L, Tan-McGrory A, Horner G, Betancourt JR. Eliminating disparities among Latinos with type 2 diabetes: Effective eHealth strategies. J Diabetes Complications 2016; 30:554-60. [PMID: 26774790 PMCID: PMC5006182 DOI: 10.1016/j.jdiacomp.2015.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/16/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022]
Abstract
Latinos are at increased risk for obesity and type 2 diabetes (T2D). Well-designed information technology (IT) interventions have been shown to be generally efficacious in improving diabetes self-management. However, there are very few published IT intervention studies focused on Latinos. With the documented close of the digital divide, Latinos stand to benefit from such advances. There are limited studies on how best to address the unique socio-cultural-linguistic characteristics that would optimize adoption, use and benefit among Latinos. Successful e-health programs involve frequent communication, bidirectionality including feedback, and multimodal delivery of the intervention. The use of community health workers (CHWs) has been shown consistently to improve T2D outcomes in Latinos. Incorporating CHWs into eHealth interventions is likely to address barriers with technology literacy and improve patient activation, satisfaction and adherence. Additionally, tailored interventions are more successful in improving patient activation. It is important to note that tailoring is more than linguistic translation; tailoring interventions to the Latino population will need to address educational, language, literacy and acculturation levels, along with unique illness beliefs and attitudes about T2D found among Latinos. Interventions will need to go beyond the lone participant and include shared decision making models that incorporate family members and friends.
Collapse
Affiliation(s)
- Lenny López
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA; Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA.
| | - Aswita Tan-McGrory
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Gabrielle Horner
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
15
|
Magaña S, Li H, Miranda E, Paradiso de Sayu R. Improving health behaviours of Latina mothers of youths and adults with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:397-410. [PMID: 24761812 DOI: 10.1111/jir.12139] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Latina mothers who care for children with intellectual and developmental disabilities (IDD) over the lifespan struggle to take care of their own health needs in the context of their caregiving experience. Services are typically aimed at the persons with IDD and not their family caregivers. Yet, attending to family caregiver needs may contribute to better long-term care of persons with IDD who remain at home. To address this unmet need, we developed a culturally sensitive health education intervention for Latina mothers who care for youth and adults with IDD. The aim of the intervention is to improve maternal health-related self-efficacy and health behaviours, and to reduce stress. METHOD A randomised control design was employed to determine preliminary efficacy of the intervention. Paired sample t-tests were conducted to examine within-group changes from baseline to 3-month post-test. Repeated-measures analysis of covariance was used to examine the group-by-time interaction effects. RESULTS Intervention participants showed greater increases between pre- and post-test in health-related self-efficacy; self-care, nutrition and overall health behaviours. Both groups reported decreases in depressive symptoms and caregiver burden. CONCLUSIONS While additional research is needed to determine long-term effects and to replicate findings, our results suggest that this culturally sensitive health intervention is a promising way to increase health behaviours which may lead to overall good health for Latina mothers who care for children with IDD across the lifespan.
Collapse
Affiliation(s)
- S Magaña
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | |
Collapse
|
16
|
A store-based intervention to increase fruit and vegetable consumption: The El Valor de Nuestra Salud cluster randomized controlled trial. Contemp Clin Trials 2015; 42:228-38. [PMID: 25924592 DOI: 10.1016/j.cct.2015.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Most evidence-based interventions to improve fruit and vegetable (FV) consumption target individual behaviors and family systems; however, these changes are difficult to sustain without environmental support. This paper describes an innovative social and structural food store-based intervention to increase availability and accessibility of FVs in tiendas (small- to medium-sized Latino food stores) and purchasing and consumption of FVs among tienda customers. METHODS Using a cluster randomized controlled trial with 16 tiendas pair-matched and randomized to an intervention or wait-list control condition, this study will evaluate a 2-month intervention directed at tiendas, managers, and employees followed by a 4-month customer-directed food marketing campaign. The intervention involves social (e.g., employee trainings) and structural (e.g., infrastructure) environmental changes. Three hundred sixty-nine customers (approximately 23 per tienda) serve on an evaluation cohort and complete assessments (interviews and measurements of weight) at 3 time points: baseline, 6-months post-baseline, and 12-months post-baseline. The primary study outcome is customer-reported daily consumption of FVs. Manager interviews and monthly tienda audits and collection of sales data will provide evidence of tienda-level intervention effects, our secondary outcomes. Process evaluation methods assess dose delivered, dose received, and fidelity. RESULTS Recruitment of tiendas, managers, employees, and customers is complete. Demographic data shows that 30% of the customers are males, thus providing a unique opportunity to examine the effects of a tienda-based intervention on Latino men. CONCLUSIONS Determining whether a tienda-based intervention can improve customers' FV purchasing and consumption will provide key evidence for how to create healthier consumer food environments.
Collapse
|
17
|
Schmied E, Parada H, Horton L, Ibarra L, Ayala G. A Process Evaluation of an Efficacious Family-Based Intervention to Promote Healthy Eating. HEALTH EDUCATION & BEHAVIOR 2015; 42:583-92. [DOI: 10.1177/1090198115577375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Entre Familia: Reflejos de Salud was a successful family-based randomized controlled trial designed to improve dietary behaviors and intake among U.S. Latino families, specifically fruit and vegetable intake. The novel intervention design merged a community health worker ( promotora) model with an entertainment-education component. This process evaluation examined intervention implementation and assessed relationships between implementation factors and dietary change. Participants included 180 mothers randomized to an intervention condition. Process evaluation measures were obtained from participant interviews and promotora notes and included fidelity, dose delivered (i.e., minutes of promotora in-person contact with families, number of promotora home visits), and dose received (i.e., participant use of and satisfaction with intervention materials). Outcome variables included changes in vegetable intake and the use of behavioral strategies to increase dietary fiber and decrease dietary fat intake. Participant satisfaction was high, and fidelity was achieved; 87.5% of families received the planned number of promotora home visits. In the multivariable model, satisfaction with intervention materials predicted more frequent use of strategies to increase dietary fiber ( p ≤ .01). Trends suggested that keeping families in the prescribed intervention timeline and obtaining support from other social network members through sharing of program materials may improve changes. Study findings elucidate the relationship between specific intervention processes and dietary changes.
Collapse
Affiliation(s)
- Emily Schmied
- San Diego State University, San Diego, CA, USA
- Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Lucy Horton
- Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Guadalupe Ayala
- San Diego State University, San Diego, CA, USA
- Institute for Behavioral and Community Health, San Diego, CA, USA
| |
Collapse
|
18
|
Ayala GX, Ibarra L, Binggeli-Vallarta A, Moody J, McKenzie TL, Angulo J, Hoyt H, Chuang E, Ganiats TG, Gahagan S, Ji M, Zive M, Schmied E, Arredondo EM, Elder JP. Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD). Child Obes 2015; 11:37-47. [PMID: 25584664 PMCID: PMC4323021 DOI: 10.1089/chi.2014.0080] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. METHODS CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. CONCLUSIONS Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.
Collapse
Affiliation(s)
- Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, and the Institute for Behavioral and Community Health, San Diego, CA
| | - Leticia Ibarra
- Programs Department, Clínicas de Salud Del Pueblo, Inc., Brawley, CA
| | | | - Jamie Moody
- Institute for Behavioral and Community Health, San Diego, CA
| | - Thomas L. McKenzie
- School of Exercise and Nutrition Sciences, San Diego State University, and the Institute for Behavioral and Community Health, San Diego, CA
| | | | - Helina Hoyt
- College of Nursing, San Diego State University, Imperial Valley Campus, Calexico, CA
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Theodore G. Ganiats
- Department of Family and Preventive Medicine, School of Medicine, University of California San Diego, La Jolla, CA
| | - Sheila Gahagan
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL
| | - Michelle Zive
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA
| | - Emily Schmied
- San Diego State University–University of California at San Diego, Joint Doctoral Program in Public Health (Health Behavior) and the Institute for Behavioral and Community Health, San Diego, CA
| | - Elva M. Arredondo
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, and the Institute for Behavioral and Community Health, San Diego, CA
| | - John P. Elder
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, and the Institute for Behavioral and Community Health, San Diego, CA
| |
Collapse
|
19
|
Elder JP, Ayala GX, McKenzie TL, Litrownik AJ, Gallo LC, Arredondo EM, Talavera GA, Kaplan RM. A three-decade evolution to transdisciplinary research: community health research in California-Mexico border communities. Prog Community Health Partnersh 2015; 8:397-404. [PMID: 25435566 DOI: 10.1353/cpr.2014.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Institute for Behavioral and Community Health (IBACH) is a transdisciplinary organization with a team-oriented approach to the translation of research to practice and policy within the context of behavioral medicine. OBJECTIVES This paper tracks the growth of IBACH in the context of evolving, multi-university transdisciplinary research efforts from a behavioral medicine research focus to community approaches to disease prevention and control, ultimately specializing in Latino health research and practice. We describe how this growth was informed by our partnerships with community members and organizations, and training a diverse array of students and young professionals. METHODS Since 1982, IBACH's research has evolved to address a greater breadth of factors associated with health and well-being. This was driven by our strong community focus and emphasis on collaborations, the diversity of our investigative teams, and our emphasis on training. Although behavioral science still forms the core of IBACH's scientific orientation, research efforts extend beyond those traditionally examined. CONCLUSIONS IBACH's "team science" successes have been fueled by a specific population emphasis, making IBACH one of the nation's leaders in Latino health behavior research.
Collapse
|
20
|
Ayala GX, Ibarra L, Horton L, Arredondo EM, Slymen DJ, Engelberg M, Rock CL, Hernandez E, Parada H, Elder JP. Evidence supporting a promotora-delivered entertainment education intervention for improving mothers' dietary intake: the Entre Familia: Reflejos de Salud Study. JOURNAL OF HEALTH COMMUNICATION 2014; 20:165-176. [PMID: 25375276 DOI: 10.1080/10810730.2014.917747] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention or delayed treatment condition. The intervention involved promotoras (community health workers) who delivered 11 home visits and 4 telephone calls. Home visits included a 12-minute episode of a 9-part situation comedy depicting a family struggling with making healthy eating choices; an accompanying family workbook was reviewed to build skills and left with the family. Baseline and immediate postintervention data were collected from the mothers, including the primary outcome of daily servings of fruits and vegetables. Other dietary and psychosocial factors related to healthy eating were examined. At postintervention, mothers in the intervention reported increases in daily vegetable servings (p ≤ .05); however, no changes were observed in fruit consumption. Improvements were observed in behavioral strategies to increase fiber (p ≤ .001) and to decrease fat intake (p ≤ .001), unhealthy eating behaviors (p ≤ .001), and individual (p ≤ .05) and family-related (p ≤ .01) perceived barriers to healthy eating. Entertainment education and promotoras engaged families and improved mothers' diets. Further research should examine the dose needed for greater changes.
Collapse
|
21
|
Mirambeau AM, Wang G, Ruggles L, Dunet DO. A cost analysis of a community health worker program in rural Vermont. J Community Health 2014; 38:1050-7. [PMID: 23794072 DOI: 10.1007/s10900-013-9713-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67%) for personnel and $139,285 (33%) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions.
Collapse
Affiliation(s)
- Alberta M Mirambeau
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-72, Atlanta, GA, 30341, USA,
| | | | | | | |
Collapse
|
22
|
Sánchez V, Cacari Stone L, Moffett ML, Nguyen P, Muhammad M, Bruna S, Urias-Chauvin R. Process evaluation of a promotora de salud intervention for improving hypertension outcomes for Latinos living in a rural U.S.-Mexico border region. Health Promot Pract 2014; 15:356-64. [PMID: 24396118 DOI: 10.1177/1524839913516343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hypertension is a growing public health problem for U.S.-Mexico border Latinos, who commonly experience low levels of awareness, treatment, and control. We report on a process evaluation that assessed the delivery of Corazón por la Vida, a 9-week promotora de salud-led curriculum to help Latinos manage and reduce hypertension risks in two rural/frontier counties in the New Mexico border region. Ninety-six adults participated in the program, delivered in three waves and in three communities. We assessed program delivery and quality, adherence, exposure, and participant responsiveness. Participant outcome measures included self-reported eating and physical activities and assessment of community resources. Findings suggest that the program was fully delivered (99%) and that most participants (81.7%) were very satisfied with the educational sessions. The average participant attendance for educational sessions was 77.47%. We found significant differences in self-reported behavioral changes depending on the number of sessions completed: The higher the dose of sessions, the better the self-reported outcomes. These findings suggest that a promotora-led curriculum may be useful for promoting self-management of chronic disease in rural/frontier border Latino populations. Future evaluation should focus on training and implementation adaptations within evidence-based chronic disease programs for diverse Latino communities.
Collapse
|
23
|
Philis-Tsimikas A, Fortmann AL, Dharkar-Surber S, Euyoque JA, Ruiz M, Schultz J, Gallo LC. Dulce Mothers: an intervention to reduce diabetes and cardiovascular risk in Latinas after gestational diabetes. Transl Behav Med 2014; 4:18-25. [PMID: 24653773 DOI: 10.1007/s13142-014-0253-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Latina women with prior gestational diabetes mellitus (GDM) are at elevated risk for type 2 diabetes mellitus and cardiovascular disease. Few primary prevention programs are designed for low socioeconomic status, Spanish-speaking populations. We examined the effectiveness of a Diabetes Prevention Program (DPP) translation in low-income Latinas with a history of GDM. Eighty-four Latinas, 18-45 years old with GDM in the past 3 years, underwent an 8-week peer-educator-led group intervention, with tailoring for Latino culture and recent motherhood. Lifestyle changes and diabetes and cardiovascular risk factors were assessed at study baseline, month 3 and month 6. Participants showed significant improvements in lipids, blood pressure, physical activity, dietary fat intake, and fatalistic and cultural diabetes beliefs (p < 0.05). Formative evaluation provides preliminary evidence of program acceptability. A peer-led, culturally appropriate DPP translation was effective in improving lifestyle changes and some indicators of cardiovascular and diabetes risk in Latinas with GDM.
Collapse
Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Sapna Dharkar-Surber
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | - Johanna A Euyoque
- Department of Psychology, San Diego State University, San Diego, CA USA
| | - Monica Ruiz
- Scripps Whittier Diabetes Institute, Scripps Health, 10140 Campus Point Drive Suite 200, San Diego, CA 92121 USA
| | | | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA USA
| |
Collapse
|
24
|
Cristancho S, Peters K, Garces M. Health information preferences among Hispanic/Latino immigrants in the U.S. rural Midwest. Glob Health Promot 2014; 21:40-9. [PMID: 24492251 DOI: 10.1177/1757975913510727] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated whether length of residence and other socio-demographic factors affect how rural Hispanic/Latino immigrants in the U.S. prefer to receive general health information. As part of a federally-funded participatory research project, we surveyed 894 adult Hispanics who were recruited through schools, community-based organizations (CBO) and faith-based organizations (FBO) in six rural communities of Illinois. Data suggest that workshops in Spanish at community settings are the most preferred health information strategy and home visits the least. Preference for these two strategies decreased significantly in the second generation, while preference for mailed printed materials increased. We further explored the role of length of residence in the U.S. on 'in-person' and 'impersonal' health information preferences controlling for other relevant socio-demographic factors finding that first generation and less educated Hispanic immigrants' prefer 'in-person' strategies. These findings suggest that rural health organizations and practitioners should implement not only culturally-appropriate but also acculturation-sensitive approaches to address Hispanic/Latino immigrants' specific health information needs.
Collapse
|
25
|
Trejo G, Arcury TA, Grzywacz JG, Tapia J, Quandt SA. Barriers and facilitators for promotoras' success in delivering pesticide safety education to Latino farmworker families: La Familia Sana. J Agromedicine 2014; 18:75-86. [PMID: 23540298 DOI: 10.1080/1059924x.2013.766143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite widespread use of lay health advisor (LHA) programs, factors related to success of LHAs remain largely unexamined. This study describes experiences and personal transformations of LHAs (promotoras de salud) in a pesticide safety education program targeting farmworker families in North Carolina, using postintervention in-depth interviews conducted with 17 LHAs. LHAs identified assets and barriers that affected their success. LHAs also described increases in self-efficacy and empowerment resulting in perceived improvements in ability to teach and impact their community. Such positive changes are essential benefits to the LHAs. Evaluations that address these topics are needed to better understand continuity and attrition in LHA programs.
Collapse
Affiliation(s)
- Grisel Trejo
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | | | | | | | |
Collapse
|
26
|
Ko LK, Reuland D, Jolles M, Clay R, Pignone M. Cultural and linguistic adaptation of a multimedia colorectal cancer screening decision aid for Spanish-speaking Latinos. JOURNAL OF HEALTH COMMUNICATION 2013; 19:192-209. [PMID: 24328496 PMCID: PMC4157647 DOI: 10.1080/10810730.2013.811325] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse, vulnerable populations, including Latinos. To address such disparities, health communication interventionists often face the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. The authors describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish-language version of an evidence-based (English language) multimedia colorectal cancer screening decision aid. The multistep process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. The authors integrated these findings in the creation of the new adapted intervention. They describe how they used this process to identify and integrate sociocultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish-language decision aid.
Collapse
Affiliation(s)
- Linda K Ko
- a Department of Cancer Prevention , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | | | | | | | | |
Collapse
|
27
|
O’Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, Matosevic T, Harden A, Thomas J. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. PUBLIC HEALTH RESEARCH 2013. [DOI: 10.3310/phr01040] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCommunity engagement has been advanced as a promising way of improving health and reducing health inequalities; however, the approach is not yet supported by a strong evidence base.ObjectivesTo undertake a multimethod systematic review which builds on the evidence that underpins the current UK guidance on community engagement; to identify theoretical models underpinning community engagement; to explore mechanisms and contexts through which communities are engaged; to identify community engagement approaches that are effective in reducing health inequalities, under what circumstances and for whom; and to determine the processes and costs associated with their implementation.Data sourcesDatabases including the Cochrane Database of Systematic Reviews (CDSR), The Campbell Library, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) database, the NHS Economic Evaluation Database (NHS EED) and EPPI-Centre’s Trials Register of Promoting Health Interventions (TRoPHI) and Database of Promoting Health Effectiveness Reviews (DoPHER) were searched from 1990 to August 2011 for systematic reviews and primary studies. Trials evaluating community engagement interventions reporting health outcomes were included.Review methodsStudy eligibility criteria: published after 1990; outcome, economic, or process evaluation; intervention relevant to community engagement; written in English; measured and reported health or community outcomes, or presents cost, resource, or implementation data characterises study populations or reports differential impacts in terms of social determinants of health; conducted in an Organisation for Economic Co-operation and Development (OECD) country. Study appraisal: risk of bias for outcome evaluations; assessment of validity and relevance for process evaluations; comparison against an economic evaluation checklist for economic evaluations. Synthesis methods: four synthesis approaches were adopted for the different evidence types: theoretical, quantitative, process, and economic evidence.ResultsThe theoretical synthesis identified key models of community engagement that are underpinned by different theories of changes. Results from 131 studies included in a meta-analysis indicate that there is solid evidence that community engagement interventions have a positive impact on health behaviours, health consequences, self-efficacy and perceived social support outcomes, across various conditions. There is insufficient evidence – particularly for long-term outcomes and indirect beneficiaries – to determine whether one particular model of community engagement is likely to be more effective than any other. There are also insufficient data to test the effects on health inequalities, although there is some evidence to suggest that interventions that improve social inequalities (as measured by social support) also improve health behaviours. There is weak evidence from the effectiveness and process evaluations that certain implementation factors may affect intervention success. From the economic analysis, there is weak but inconsistent evidence that community engagement interventions are cost-effective. By combining findings across the syntheses, we produced a new conceptual framework.LimitationsDifferences in the populations, intervention approaches and health outcomes made it difficult to pinpoint specific strategies for intervention effectiveness. The syntheses of process and economic evidence were limited by the small (generally not rigorous) evidence base.ConclusionsCommunity engagement interventions are effective across a wide range of contexts and using a variety of mechanisms. Public health initiatives should incorporate community engagement into intervention design. Evaluations should place greater emphasis on long-term outcomes, outcomes for indirect beneficiaries, process evaluation, and reporting costs and resources data. The theories of change identified and the newly developed conceptual framework are useful tools for researchers and practitioners. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation.FundingThe National Institute for Health Research Public Health Research programme.
Collapse
Affiliation(s)
- A O’Mara-Eves
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - G Brunton
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - D McDaid
- Personal Social Services Research Unit and European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - S Oliver
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - J Kavanagh
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| | - F Jamal
- Institute for Health and Human Development, University of East London, London, UK
| | - T Matosevic
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - A Harden
- Institute for Health and Human Development, University of East London, London, UK
- Barts Health NHS Trust, London, UK
| | - J Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Institute of Education, London, UK
| |
Collapse
|
28
|
Nierkens V, Hartman MA, Nicolaou M, Vissenberg C, Beune EJAJ, Hosper K, van Valkengoed IG, Stronks K. Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities. a systematic review. PLoS One 2013; 8:e73373. [PMID: 24116000 PMCID: PMC3792111 DOI: 10.1371/journal.pone.0073373] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/25/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions. AIM To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness. METHODS Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997-2009). INCLUSION CRITERIA a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity. RESULTS Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity. CONCLUSION This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US.
Collapse
Affiliation(s)
- Vera Nierkens
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Marieke A. Hartman
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Vissenberg
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Erik J. A. J. Beune
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Hosper
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Irene G. van Valkengoed
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Academic Medical Center – University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
29
|
van der Veen YJJ, van Empelen P, de Zwart O, Visser H, Mackenbach JP, Richardus JH. Cultural tailoring to promote hepatitis B screening in Turkish Dutch: a randomized control study. Health Promot Int 2013; 29:692-704. [DOI: 10.1093/heapro/dat020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
30
|
Broekhuizen K, Kroeze W, van Poppel MNM, Oenema A, Brug J. A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update. Ann Behav Med 2013; 44:259-86. [PMID: 22767052 PMCID: PMC3442159 DOI: 10.1007/s12160-012-9384-3] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A review update is necessary to document evidence regarding the effectiveness of computer-tailored physical activity and nutrition education. Purpose The purpose of this study was to summarize the latest evidence on the effectiveness of computer-tailored physical activity and nutrition education, and to compare the results to the 2006 review. Methods Databases were searched for randomized controlled trials evaluating computer-tailored physical activity and nutrition education aimed at primary prevention in adults, published from September 2004 through June 2011. Results Compared to the findings in 2006, a larger proportion of studies found positive effects for computer-tailored programs compared to generic or no information, including those for physical activity promotion. Effect sizes were small and generally at short- or medium-term follow-up. Conclusions The results of the 2006 review were confirmed and reinforced. Future interventions should focus on establishing larger effect sizes and sustained effects and include more generic health education control groups and objective measurements of dietary behavior. Electronic supplementary material The online version of this article (doi:10.1007/s12160-012-9384-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karen Broekhuizen
- EMGO+ Institute for Health and Care Research, Amsterdam, Netherlands.
| | | | | | | | | |
Collapse
|
31
|
Goris J, Komaric N, Guandalini A, Francis D, Hawes E. Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: a systematic literature review. Aust J Prim Health 2013; 19:14-37. [DOI: 10.1071/py11130] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 02/10/2012] [Indexed: 11/23/2022]
Abstract
With a large and increasing culturally and linguistically diverse (CALD) population, the Australian health care system faces challenges in the provision of accessible culturally competent health care. Communities at higher risk of chronic disease include CALD communities. Overseas, multicultural health workers (MHWs) have been increasingly integrated in the delivery of culturally relevant primary health care to CALD communities. The objective of this systematic review was to examine the effectiveness of MHW interventions in chronic disease prevention and self-management in CALD populations with the aim to inform policy development of effective health care in CALD communities in Australia. A systematic review protocol was developed and computerised searches were conducted of multiple electronic databases from 1 January 1995 until 1 November 2010. Thirty-nine studies were identified including 31 randomised controlled trials. Many of the studies focussed on poor and underserved ethnic minorities. Several studies reported significant improvements in participants’ chronic disease prevention and self-management outcomes and meta-analyses identified a positive trend associated with MHW intervention. Australian Government policies express the need for targeted inventions for CALD communities. The broader systemic application of MHWs in Australian primary health care may provide one of the most useful targeted interventions for CALD communities.
Collapse
|
32
|
Establishing a professional profile of community health workers: results from a national study of roles, activities and training. J Community Health 2012; 37:529-37. [PMID: 21964912 DOI: 10.1007/s10900-011-9475-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Community Health Workers (CHWs) have gained national recognition for their role in addressing health disparities and are increasingly integrated into the health care delivery system. There is a lack of consensus, however, regarding empirical evidence on the impact of CHW interventions on health outcomes. In this paper, we present results from the 2010 National Community Health Worker Advocacy Survey (NCHWAS) in an effort to strengthen a generalized understanding of the CHW profession that can be integrated into ongoing efforts to improve the health care delivery system. Results indicate that regardless of geographical location, work setting, and demographic characteristics, CHWs generally share similar professional characteristics, training preparation, and job activities. CHWs are likely to be female, representative of the community they serve, and to work in community health centers, clinics, community-based organizations, and health departments. The most common type of training is on-the-job and conference training. Most CHWs work with clients, groups, other CHWs and less frequently community leaders to address health issues, the most common of which are chronic disease, prevention and health care access. Descriptions of CHW activities documented in the survey demonstrate that CHWs apply core competencies in a synergistic manner in an effort to assure that their clients get the services they need. NCHWAS findings suggest that over the past 50 years, the CHW field has become standardized in response to the unmet needs of their communities. In research and practice, the field would benefit from being considered a health profession rather than an intervention.
Collapse
|
33
|
Gallo LC, Fortmann AL, de Los Monteros KE, Mills PJ, Barrett-Connor E, Roesch SC, Matthews KA. Individual and neighborhood socioeconomic status and inflammation in Mexican American women: what is the role of obesity? Psychosom Med 2012; 74:535-42. [PMID: 22582313 PMCID: PMC3372661 DOI: 10.1097/psy.0b013e31824f5f6d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Inflammation may represent a biological mechanism underlying associations of socioeconomic status (SES) with cardiovascular disease. We examined relationships of individual and neighborhood SES with inflammatory markers in Mexican American women and evaluated contributions of obesity and related heath behaviors to these associations. METHODS Two hundred eighty-four Mexican American women (mean age = 49.74 years) were recruited from socioeconomically diverse South San Diego communities. Women completed measures of sociodemographic characteristics and health behaviors, and underwent a physical examination with fasting blood draw for assay of plasma C-reactive protein (CRP), interleukin 6 (IL-6), and soluble intercellular adhesion molecule 1 (sICAM-1). Neighborhood SES was extracted from the US Census Bureau 2000 database. RESULTS In multilevel models, a 1-standard deviation higher individual or neighborhood SES related to a 27.35% and 23.56% lower CRP level (p values < .01), a 7.04% and 5.32% lower sICAM-1 level (p values < .05), and a 10.46% (p < .05) and 2.40% lower IL-6 level (not significant), respectively. Controlling for individual SES, a 1-standard deviation higher neighborhood SES related to a 18.05% lower CRP level (p = .07). Differences in body mass index, waist circumference, and dietary fat consumption contributed significantly to SES-inflammation associations. CONCLUSIONS The findings support a link between SES and inflammatory markers in Mexican American women and implicate obesity and dietary fat in these associations. Additional effects of neighborhood SES were not statistically significant; however, these findings should be viewed tentatively due to the small sample size to evaluate contextual effects. Trial Registration ClinicalTrials.gov identifier: NCT00387166.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego StateUniversity, San Diego, CA, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Crespo NC, Elder JP, Ayala GX, Campbell NR, Arredondo EM, Slymen DJ, Baquero B, Sallis JF, McKenzie TL. Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Niños Study. Ann Behav Med 2012; 43:84-100. [PMID: 22215470 PMCID: PMC4131843 DOI: 10.1007/s12160-011-9332-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Community-based interventions are needed to reduce the burden of childhood obesity. PURPOSE To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children. METHODS Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2(nd) grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors. RESULTS There were no significant intervention effects on children's BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring). CONCLUSION A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.
Collapse
Affiliation(s)
- Noe C. Crespo
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - John P. Elder
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - Guadalupe X. Ayala
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - Nadia R. Campbell
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - Elva M. Arredondo
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - Donald J. Slymen
- Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 211, San Diego, CA 92123, USA
| | - Barbara Baquero
- Health Behavior and Health Education, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - James F. Sallis
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Thomas L. McKenzie
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| |
Collapse
|
35
|
Arvey SR, Fernandez ME, LaRue DM, Bartholomew LK. When promotoras and technology meet: a qualitative analysis of promotoras' use of small media to increase cancer screening among South Texas Latinos. HEALTH EDUCATION & BEHAVIOR 2011; 39:352-63. [PMID: 21986243 DOI: 10.1177/1090198111418110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Computer-based multimedia technologies can be used to tailor health messages, but promotoras (Spanish-speaking community health workers) rarely use these tools. Promotoras delivered health messages about colorectal cancer screening to medically underserved Latinos in South Texas using two small media formats: a "low-tech" format (flipchart and video) and a "high-tech" format consisting of a tailored, interactive computer program delivered on a tablet computer. Using qualitative methods, the authors observed promotora training and intervention delivery and conducted interviews with five promotoras to compare and contrast program implementation of both formats. The authors discuss the ways each format aided or challenged promotoras' intervention delivery. Findings reveal that some aspects of both formats enhanced intervention delivery by tapping into Latino health communication preferences and facilitating interpersonal communication, whereas other aspects hindered intervention delivery. This study contributes to our understanding of how community health workers use low- and high-tech small media formats when delivering health messages to Latinos.
Collapse
|
36
|
Gallo LC, Jiménez JA, Shivpuri S, Espinosa de los Monteros K, Mills PJ. Domains of chronic stress, lifestyle factors, and allostatic load in middle-aged Mexican-American women. Ann Behav Med 2011; 41:21-31. [PMID: 20878511 PMCID: PMC3030741 DOI: 10.1007/s12160-010-9233-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Little research has examined how chronic stress in different domains relates to allostatic load (AL). Purpose We examined the relationship between multiple chronic stressors with AL, and evaluated lifestyle factors as possible mediating factors. Methods Three hundred one middle-aged Mexican-American women underwent a physical exam and completed measures of lifestyle factors and chronic stress in eight domains. A composite of 12 neuroendocrine, metabolic, cardiovascular, and inflammatory markers represented AL. Results Chronic work, financial, and caregiving domains related to higher AL scores after adjusting for covariates and other stressors. Lifestyle factors made little contribution to the association between stressors and AL. Conclusions Chronic work, financial, and caregiving stressors are associated with physiological dysregulation in Mexican-American women. This study is among the first to examine multiple domains of chronic stress in relation to AL, in a population that has been understudied in research concerning stress and health.
Collapse
Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, CA 92123, USA.
| | | | | | | | | |
Collapse
|
37
|
Dauer LT, Thornton RH, Hay JL, Balter R, Williamson MJ, St Germain J. Fears, feelings, and facts: interactively communicating benefits and risks of medical radiation with patients. AJR Am J Roentgenol 2011; 196:756-61. [PMID: 21427321 PMCID: PMC3816522 DOI: 10.2214/ajr.10.5956] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE As public awareness of medical radiation exposure increases, there has been heightened awareness among patients and physicians of the importance of holistic benefit-and-risk discussions in shared medical decision making. CONCLUSION We examine the rationale for informed consent and risk communication, draw on the literature on the psychology of radiation risk communication to increase understanding, examine methods commonly used to communicate radiation risk, and suggest strategies for improving communication about medical radiation benefits and risk.
Collapse
Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 84, New York, NY 10065, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Waitzkin H, Getrich C, Heying S, Rodríguez L, Parmar A, Willging C, Yager J, Santos R. Promotoras as mental health practitioners in primary care: a multi-method study of an intervention to address contextual sources of depression. J Community Health 2011; 36:316-31. [PMID: 20882400 PMCID: PMC3051073 DOI: 10.1007/s10900-010-9313-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We assessed the role of promotoras--briefly trained community health workers--in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention's impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention's implementation, involving infrastructure at the health centers, boundaries of the promotoras' roles, and "turf" issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers.
Collapse
|
39
|
Elder JP, McKenzie TL, Arredondo EM, Crespo NC, Ayala GX. Effects of a multi-pronged intervention on children's activity levels at recess: the Aventuras para Niños study. Adv Nutr 2011; 2:171S-6S. [PMID: 22332049 PMCID: PMC3065761 DOI: 10.3945/an.111.000380] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Latino children spend more time in sedentary activities than other American children, and only ~1 in 5 Latino children in public elementary and middle schools meet all 6 fitness standards in statewide fitness testing. Schools that facilitate physical activity (PA) by maintaining playgrounds and providing physical education classes have children who are more active and less overweight. The aims of the present study were to examine the extent to which several social and physical environmental changes in school settings resulted in observed changes in area characteristics and children's activity levels during recess. Thirteen elementary schools serving predominantly Mexican American children were randomized into control or activity and nutrition environmental intervention conditions. Playgrounds and activities were restructured in 6 intervention schools to promote more PA. After 1 y, there were no overall statistical differences between treatment groups in PA or sedentary behavior in these settings and results did not differ by gender. Changing the social and physical environments to promote children's moderate-to-vigorous PA is important to the design of active and healthy recess environments. The present results are not conclusive as to the link between these interventions and actual behavior, but show sufficient promise for further population and setting specific research.
Collapse
Affiliation(s)
- John P Elder
- Graduate School of Public Health, and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA 9245, USA
| | | | | | | | | |
Collapse
|
40
|
Davis RE, Peterson KE, Rothschild SK, Resnicow K. Pushing the envelope for cultural appropriateness: does evidence support cultural tailoring in type 2 diabetes interventions for Mexican American adults? DIABETES EDUCATOR 2011; 37:227-38. [PMID: 21343599 DOI: 10.1177/0145721710395329] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study explores the potential utility of a culturally tailored diabetes management intervention approach by testing associations between acculturation and diabetes-related beliefs among Mexican-American adults with type 2 diabetes. METHODS Data from 288 Mexican-American adults with type 2 diabetes were obtained via a bilingual, telephone-administered survey. Participants were drawn from a stratified, random sample designed to obtain maximum variability in acculturation. The survey assessed diabetes-related beliefs, intervention preferences, and the following three acculturation constructs from the Hazuda acculturation and assimilation scales: Spanish use, value for preserving Mexican culture, and interaction with Mexican Americans. RESULTS Only one outcome-preference for a program for Mexican Americans-was associated with all three acculturation variables. Spanish use was positively associated with belief in susto as a cause of diabetes, preference for expert-driven health guidance, and involvement of others in taking care of diabetes. Value for preserving Mexican culture was related to a more holistic view of health, as evidenced by an increased likelihood of consulting a curandero, use of prayer, and interest in a diabetes program with religious content. Value for cultural preservation was also related to higher suspicion of free diabetes programs. Interaction with Mexican Americans was associated with a belief that insulin causes blindness. CONCLUSION Findings from this study suggest distinct relationships between acculturation constructs and diabetes-related beliefs and preferences, thus arguing against the use of a single acculturation construct to determine diabetes intervention design. Cultural tailoring may enhance the cultural appropriateness and ultimate effectiveness of diabetes interventions for Mexican American adults.
Collapse
Affiliation(s)
- Rachel E Davis
- The Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Davis, Dr Peterson)
| | - Karen E Peterson
- The Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Davis, Dr Peterson)
| | - Steven K Rothschild
- Preventive Medicine, Rush University Medical Center, Chicago, Illinois (Dr Rothschild)
| | - Ken Resnicow
- The Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan (Dr Resnicow)
| |
Collapse
|
41
|
Springgate B, Wennerstrom A, Carriere C. Capacity Building for Post-Disaster Mental Health since Katrina: The Role of Community Health Workers. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s12114-010-9083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The floods and devastation of Hurricanes Katrina and Rita contributed to socioeconomic instability and psychosocial trauma for the affected communities and populations, significantly for people of limited economic means and persons of color. Though more than 1/3 of the adult population from impacted areas experienced significant psychological distress, few people had access to or received appropriate health or mental health services in the months and years that followed. Community health workers (CHWs)—defined as lay community members whose backgrounds are similar to those for whom they provide such services as culturally relevant health education, individual- and community-level advocacy, and links to the health care system— may represent a particularly promising workforce strategy to increase access to quality mental health services and overcome racial and ethnic disparities in care. In this paper, we briefly review a post-disaster mental health training program for CHWs from the greater New Orleans area. We present preliminary evidence that CHWs remain engaged in addressing post-disaster concerns, and that there is community support for further CHW education. We discuss implications for CHW participation in recovery from future disasters and we highlight the work of Cynthia Carriere, a CHW from the Lower 9th Ward in New Orleans.
Collapse
Affiliation(s)
- Benjamin Springgate
- Tulane University School of Medicine, 1430 Tulane Ave. SL-16, New Orleans, LA 70112, USA
- RAND Corporation, New Orleans, LA, USA
- REACH NOLA, New Orleans, LA, USA
| | - Ashley Wennerstrom
- Tulane University School of Medicine, 1430 Tulane Ave. SL-16, New Orleans, LA 70112, USA
- Tulane University School of Public Health and Tropical Medicine, Department of Community Health Sciences, New Orleans, LA, USA
| | | |
Collapse
|
42
|
Abstract
Tailored health communication research represents a very promising line of inquiry that has the potential to produce major impacts on lifestyle behaviors. This study defines tailoring and discusses how tailored interventions operate, including comparing/ contrasting different tailoring channels. Next, the authors review the literature on tailored interventions to change lifestyle behaviors, with a focus on smoking cessation, dietary change, and physical activity, as well as interventions that address multiple lifestyle behaviors. Finally, future directions for tailoring research are discussed. To date, a large literature has amassed showing the promise of tailored programs delivered via print, Internet, local computer/kiosk, telephone, and interpersonal channels. Numerous studies demonstrate that these programs are capable of significant impacts on smoking cessation, dietary change, physical activity, and multiple behavior change. It is concluded that the potential of tailoring will be more fully realized as (a) the field builds a more cumulative science of tailoring and (b) greater dissemination of efficacious tailored programs takes place.
Collapse
|
43
|
Ayala GX, Vaz L, Earp JA, Elder JP, Cherrington A. Outcome effectiveness of the lay health advisor model among Latinos in the United States: an examination by role. HEALTH EDUCATION RESEARCH 2010; 25:815-40. [PMID: 20603384 PMCID: PMC2948840 DOI: 10.1093/her/cyq035] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 05/23/2010] [Indexed: 05/06/2023]
Abstract
The objective of this study was to examine lay health advisor (LHA) programs designed to promote health among US Latinos and the extent to which educator-only versus educator-plus-bridge programs differed in designs and outcomes achieved. Two independent coders reviewed 128 published articles on LHAs yielding information at two levels: (i) study design and participant and LHA characteristics from 61 studies that broadly compared educator-only versus educator-plus-bridge programs and (ii) implementation features and outcomes from 17 randomized controlled trials or quasi-experimental studies with outcome data. LHA programs have been widely used with Latinos in certain US regions; our findings indicate that LHAs are effective intervention agents. We identified differences between educator-only and educator-plus-bridge LHA programs, although the small number of educator-plus-bridge programs with outcome data limited comparisons. Major gaps remain in research targeting Latino subgroups other than Mexican immigrants/Mexican Americans. Sufficient research has evaluated LHA programs among Latinos on their ability to achieve health behavior and/or health status changes. In the future, more of a focus on organizational and policy changes is warranted. Questions remain about diversity in LHAs' characteristics and roles, which influence not only outcomes but also program sustainability and dissemination.
Collapse
Affiliation(s)
- Guadalupe X Ayala
- Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA.
| | | | | | | | | |
Collapse
|
44
|
Abstract
OBJECTIVES We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved. RESEARCH DESIGN We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus. RESULTS We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions. CONCLUSIONS CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.
Collapse
|
45
|
Rosero EB, Kane K, Clagett GP, Timaran CH. A systematic review of the limitations and approaches to improve detection and management of peripheral arterial disease in Hispanics. J Vasc Surg 2010; 51:27S-35S. [DOI: 10.1016/j.jvs.2009.08.085] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 08/20/2009] [Accepted: 08/23/2009] [Indexed: 11/25/2022]
|
46
|
Ayala GX, Elder JP, Campbell NR, Arredondo E, Baquero B, Crespo NC, Slymen DJ. Longitudinal intervention effects on parenting of the Aventuras para Niños study. Am J Prev Med 2010; 38:154-62. [PMID: 20117571 PMCID: PMC2832210 DOI: 10.1016/j.amepre.2009.09.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 08/21/2009] [Accepted: 09/21/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences. PURPOSE This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity. DESIGN The study used a 2 x 2 factorial design. SETTING/PARTICIPANTS In 2003, a sample of 13 Southern California schools was randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro-environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade. INTERVENTION In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters. MAIN OUTCOME MEASURES In 2008, intervention effects were examined on (1) parenting strategies, including limit setting, monitoring, discipline, control, and reinforcement related to children's diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to children's eating and activity. RESULTS At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions. CONCLUSIONS Aspects of parenting related to children's risk for obesity and related health outcomes are modifiable with the support of a promotora and print media.
Collapse
Affiliation(s)
- Guadalupe X Ayala
- San Diego State University, Graduate School of Public Health, San Diego, California, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
Kaphingst KA, Lachance CR, Gepp A, D'Anna LH, Rios-Ellis B. Educating underserved Latino communities about family health history using lay health advisors. Public Health Genomics 2009; 14:211-21. [PMID: 20051669 DOI: 10.1159/000272456] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Family health history (FHH) is a tool used to inform individuals about inherited disease risk. Due to their disproportionate morbidity and mortality from some common chronic diseases, U.S. Latinos are an important audience for FHH information. This study examined the effects of a culturally-tailored intervention led by lay health advisors (LHAs) in delivering information about FHH on participants' intentions, self-efficacy, and conceptual knowledge. METHODS 474 Spanish-speaking Latino participants were enrolled in the study. Individuals in the intervention group participated in a single group educational session using discussion and interactive activities to build skills for discussing FHH with one's family members and doctor, while individuals in the comparison group had a brochure read aloud to them. Pre- and post-test questionnaires were verbally administered. RESULTS Primary dependent variables were intentions and self-efficacy to discuss FHH with family members and doctors; these increased in both groups. Multivariate analyses demonstrated that the intervention led to a significantly greater increase in self-efficacy to discuss FHH with family members (p = 0.03). LHA participants were also more than twice as likely (OR = 2.6, 95% CI = 1.3-5.0) to correctly understand the purpose of a FHH and found FHH information more useful (p < 0.0001). CONCLUSIONS A communication intervention delivered by LHAs shows promise as an effective means of educating underserved Spanish-speaking Latinos about the importance of FHH for disease prevention. Such community-based approaches can help to close knowledge and skills gaps about FHH and increase confidence in using this information to improve the health of those most at risk.
Collapse
Affiliation(s)
- K A Kaphingst
- National Human Genome Research Institute, Bethesda, MD, USA.
| | | | | | | | | |
Collapse
|
48
|
Abstract
This article provides a review of health promotion research conducted among Latinos. The authors examined 31 intervention studies promoting physical activity and/or healthy diet in Latino samples. Overall, findings suggested that Latinos are responsive to interventions promoting physical activity and healthy diet, despite facing numerous barriers to health promotion. In fact, 12 of the 21 studies that measured physical activity and 19 of the 26 studies that measured dietary behavior reported that the intervention produced significant improvements in those health behaviors. Design strengths of these studies included the high rates of retention and large number of randomized controlled trials. However, there were concerns regarding the lack of diversity in the samples (mostly Mexican American women), limiting the generalizability of the findings and the underutilization of objective measures of physical activity and diet behavior in intervention studies.
Collapse
Affiliation(s)
- Dori Pekmezi
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island,
| | - Becky Marquez
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
| | - Joshua Marcus-Blank
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
| |
Collapse
|
49
|
Baquero B, Ayala GX, Arredondo EM, Campbell NR, Slymen DJ, Gallo L, Elder JP. Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas. HEALTH EDUCATION RESEARCH 2009; 24:855-66. [PMID: 19339374 PMCID: PMC2738959 DOI: 10.1093/her/cyp022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 02/27/2009] [Indexed: 05/10/2023]
Abstract
Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US-Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change.
Collapse
Affiliation(s)
- Barbara Baquero
- Graduate School of Public Health, San Diego State University, San Diego, CA 92115, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Roberto AJ, Krieger JL, Beam MA. Enhancing web-based kidney disease prevention messages for Hispanics using targeting and tailoring. JOURNAL OF HEALTH COMMUNICATION 2009; 14:525-40. [PMID: 19731125 DOI: 10.1080/10810730903089606] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The goal of this experiment was to assess the effects of targeted and tailored web-based messages on Hispanics' perceived susceptibility to kidney disease, and on their intention to talk to a doctor about kidney disease (the recommended behavior). Two-hundred-seventeen English-speaking Hispanics age 40 and older were recruited using an online survey service, and they were assigned randomly to read one of four messages (i.e., control, generic, targeted, and tailored). The hypothesis predicted a positive linear trend between type of message received and perceived susceptibility and intentions. Results were partially consistent with this hypothesis. Specifically, perceived susceptibility to kidney disease was highest in the tailored condition, followed by the generic and targeted conditions (which did not differ from each other), followed by the control condition where perceived susceptibility was the lowest. For behavioral intention, those in the tailored, targeted, and generic conditions did not differ from one an other; however, all three did report greater intentions to ask a doctor about kidney disease than those in the control condition. The theoretical and practical insights and implications of these findings are discussed.
Collapse
|