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Ansari U, Omer K, Aziz A, Gidado Y, Mudi H, Jamaare IS, Andersson N, Cockcroft A. Added value of video edutainment on android handsets in home visits to improve maternal and child health in Bauchi State, Nigeria: Secondary analysis from a cluster randomised controlled trial. Digit Health 2024; 10:20552076241228408. [PMID: 38357586 PMCID: PMC10865940 DOI: 10.1177/20552076241228408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Objective A trial of evidence-based health promotion home visits to pregnant women and their spouses in northern Nigeria found significant improvements in maternal and child health outcomes. This study tested the added value for these outcomes of including video edutainment in the visits. Methods In total, 19,718 households in three randomly allocated intervention wards (administrative areas) received home visits including short videos on android handsets to spark discussion about local risk factors for maternal and child health; 16,751 households in three control wards received visits with only verbal discussion about risk factors. We compared outcomes between wards with and without videos in the visits, calculating the odds ratio (OR) and 95% confidence interval (95%CI) of differences, in bivariate and then multivariate analysis adjusting for socio-economic differences between the video and non-video wards. Results Pregnant women from video wards were more likely than those from non-video wards to have discussed pregnancy and childbirth often with their husbands (OR 2.22, 95%CI 1.07-4.59). Male spouses in video wards were more likely to know to give more fluids and continued feeding to a child with diarrhoea (OR 1.61, 95%CI 1.21-2.13). For most outcomes there was no significant difference between video and non-video wards. The home visitors who shared videos considered they helped pregnant women and their spouses to appreciate the information about risk factors. Conclusion The lack of added value of the videos in the context of a research study may reflect the intensive training of home visitors and the effective evidence-based discussions included in all the visits. Further research could rollout routine home visits with and without videos and test the impact of video edutainment added to home visits carried out in a routine service context.
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Affiliation(s)
- Umaira Ansari
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Amar Aziz
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women's Association of Nigeria, Bauchi, Nigeria
| | - Hadiza Mudi
- Federation of Muslim Women's Association of Nigeria, Bauchi, Nigeria
| | | | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Cockcroft
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
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Ansari U, Omer K, Gidado Y, Baba MC, Gamawa AI, Daniel LE, Andersson N, Cockcroft A. Community Groups Co-Design Evidence-Based Docudramas to Communicate About Child Spacing in Bauchi State, Nigeria: A Qualitative Descriptive Study. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 45:2752535X231221594. [PMID: 38086749 PMCID: PMC11418317 DOI: 10.1177/2752535x231221594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
In Bauchi State, northern Nigeria, communities recognise short birth interval (kunika in the Hausa language) as harmful, but family planning is a sensitive topic. This paper describes the development of a culturally safe way to communicate about kunika in a conservative Muslim setting. The objective was to co-design culturally safe communication material, based on local knowledge about short birth interval, to share with women and men in households.Six community co-design groups of women and six of men (total 96 participants) reviewed summaries of their previously created maps of perceived local causes of kunika, categorised as frequent sex, family dynamics and non-use of contraception. They advised how these causes could be discussed effectively and acceptably with women and their husbands in households and suggested storylines for three short video docudramas about the prevention of kunika. The research team created the docudramas with a local producer and fieldworkers piloted their use in households.The design groups advised that communication materials should focus on child spacing rather than on limitation of family size. Even sensitive issues could be covered. People would not change their sexual behaviour but could be advised to use contraceptives to prevent kunika. The groups approved the final videos and six focus groups of visited women and men reported they were acceptable and helpful. Community co-design of communication about kunika was feasible and led to videos about a sensitive topic that were acceptable to ordinary men and women in communities in Bauchi.
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Affiliation(s)
- Umaira Ansari
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women’s Associations of Nigeria, Bauchi, Nigeria
| | - Muhd Chadi Baba
- Federation of Muslim Women’s Associations of Nigeria, Bauchi, Nigeria
| | | | | | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
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DeNunzio M, Miller M, Chase M, Kraak V, Serrano E, Misyak S. A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States. Am J Health Promot 2023; 37:401-419. [PMID: 36112805 DOI: 10.1177/08901171221125451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS Data were analyzed by the lead investigator and described narratively. RESULTS Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.
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Affiliation(s)
- Maria DeNunzio
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Makenzie Miller
- 4366Louisiana State University AgCenter, Baton Rouge, LA, USA
| | - Melissa Chase
- Department of Food Science and Technology, 118724Virginia Tech, Blacksburg, VA, USA
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
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Johnson CM, Allicock MA, Sharkey JR, Umstattd Meyer MR, Gómez L, Prochnow T, Laviolette C, Beltrán E, Garza LM. Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11660. [PMID: 36141933 PMCID: PMC9517298 DOI: 10.3390/ijerph191811660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.
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Affiliation(s)
- Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, San Marcos, TX 78666, USA
| | - Marlyn A. Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health-Dallas Regional Campus, The University of Texas Health Science Center at Houston, Dallas, TX 75207, USA
| | - Joseph R. Sharkey
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - M. Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA
| | - Luis Gómez
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Tyler Prochnow
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Chelsey Laviolette
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, San Marcos, TX 78666, USA
| | - Elva Beltrán
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Luz M. Garza
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
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Taverno Ross SE, Liang HW, Cheng J, Fox A, Documet PI. Effectiveness of a Promotores Network to Improve Health in an Emerging Latino Community. HEALTH EDUCATION & BEHAVIOR 2022; 49:455-467. [PMID: 35473431 DOI: 10.1177/10901981221090161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, promotor-led intervention on access to care, physical activity, dietary practices, and perceived social support among Latino adults living in an emerging community, compared with a nonrandomly assigned control group. METHOD Participants (n = 81 intervention; n = 86 control) were drawn from Allegheny county, Pennsylvania. Promotores used an intervention tool offering nondirective social support to assist participants in developing SMART goals to address their life concerns in eight domains (e.g., social, diet, and exercise/recreation); the control group received printed materials. Participants completed a survey in Spanish at baseline and follow-up to assess outcomes and had their height and weight measured. Adjusted linear mixed effects models compared change in outcomes over time. RESULTS There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group. CONCLUSION This study demonstrates the potential effectiveness of a promotores network in assisting individuals living in an emerging Latino community to address their life concerns and improve health behaviors. Future studies should include objective and more rigorous measures with a larger sample to replicate these results.
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Affiliation(s)
| | | | | | - Andrea Fox
- University of Pittsburgh, Pittsburgh, PA, USA
- Squirrel Hill Health Center, Pittsburgh, PA, USA
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Shin Y, Pettigrew J. Testing Narrative Persuasion of a Culturally Grounded, School-Based "Dale Se REAL" Entertainment-Education Intervention and Peer Communication on Nicaraguan Adolescent Substance Use. JOURNAL OF HEALTH COMMUNICATION 2022; 27:222-231. [PMID: 35722984 DOI: 10.1080/10810730.2022.2090030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Guided by narrative engagement theory and social cognitive theory, the present study investigates effects of narrative persuasion and peer communication on Nicaraguan adolescent substance use. Eighth-grade students in Nicaragua were recruited to participate in the culturally grounded, school-based prevention intervention Dale se REAL and to watch five entertainment-education intervention videos that teach drug refusal communication strategies. Using the cross-sectional survey (N = 224), a path analysis was run to examine the mediated moderation effects of narrative engagement (e.g., interest, realism, and identification with main characters) and peer communication about the intervention videos (e.g., frequency and valence of communication) on adolescent refusal self-efficacy and substance use behaviors. Results revealed that realism was significantly related to adolescent refusal self-efficacy and frequent peer communication moderated the association between refusal self-efficacy and the past 30-day marijuana use. Findings suggest that health communication scholars should take into consideration social factors and cultural contexts for adolescent substance use prevention research.
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Affiliation(s)
- YoungJu Shin
- Hugh Downs School of Human Communication, Arizona State University, Tempe, Arizona, USA
| | - Jonathan Pettigrew
- Hugh Downs School of Human Communication, Arizona State University, Tempe, Arizona, USA
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Borelli JL, Cervantes BR, Hecht HK, Marquez CM, DePrado R, Torres G, Robles A, Chirinos N, Leal F, Montiel GI, Pedroza M, Guerra N. Barreras y Soluciones: Lessons learned from integrating research-based clinical techniques into a community agency serving low-income Latinx immigrant families. FAMILY PROCESS 2022; 61:108-129. [PMID: 34405407 DOI: 10.1111/famp.12712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
Barriers facing effective science-to-practice translation have led scholars to conduct early-stage intervention research within community organizations. We describe our experiences developing a manualized parent-youth attachment-based group therapy intervention within a community health organization dedicated to serving low-income Latinx immigrant families, Latino Health Access (LHA), in which services are rendered by trained community workers (promotores). By conducting a qualitative analysis of interviews with all members of this academic-community partnership (research [Principal Investigator, student researchers] and community agency team members [Administrators, promotores]), we discuss the challenges and opportunities that this collaboration has generated. The results led both the research and community teams to question assumptions about the basic skills, values, and attitudes that underlie the integration of science and practice. We will share the insights that have helped to promote connection and understanding among the stakeholders and the efforts made to support the progress and successes of developing community interventions.
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Affiliation(s)
| | | | - Hannah K Hecht
- University of California, Irvine, Irvine, California, USA
| | | | - Rosy DePrado
- Latino Health Access, Santa Ana, California, USA
| | - Gina Torres
- Latino Health Access, Santa Ana, California, USA
| | | | | | | | | | | | - Nancy Guerra
- University of California, Irvine, Irvine, California, USA
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Ayala GX, Pickrel JL, Baquero B, Sanchez-Flack J, Lin SF, Belch G, Rock CL, Linnan L, Gittelsohn J, Ji M, Elder JP, Mayer J. The El Valor de Nuestra Salud clustered randomized controlled trial store-based intervention to promote fruit and vegetable purchasing and consumption. Int J Behav Nutr Phys Act 2022; 19:19. [PMID: 35177070 PMCID: PMC8851758 DOI: 10.1186/s12966-021-01220-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months. Trial design Clustered randomized controlled trial Methods Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors. Results The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects. Conclusions Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products). Trial registration NCT01475526 Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01220-w.
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Affiliation(s)
- Guadalupe X Ayala
- Division of Health Promotion and Behavioral Sciences, School of Public Health, San Diego State University, San Diego, USA. .,Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA, 92123, USA.
| | - Julie L Pickrel
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA, 92123, USA
| | - Barbara Baquero
- Health System and Population Health, School of Public Health, University of Washington, Box 35480, Seattle, WA, 98195, USA
| | - Jennifer Sanchez-Flack
- Department of Pediatrics, University of Illinois Cancer Center, Chicago, USA.,Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, WROB 478, Chicago, IL, 60608, USA
| | - Shih-Fan Lin
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA, 92123, USA
| | - George Belch
- Marketing Department, Fowler College of Business, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Cheryl L Rock
- Department of Family Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive #0901, La Jolla, CA, 92093, USA
| | - Laura Linnan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 359 Rosenau Hall, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599, USA
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205-2179, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, 12901, USA
| | - John P Elder
- Division of Health Promotion and Behavioral Sciences, School of Public Health, San Diego State University, San Diego, USA.,Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA, 92123, USA
| | - Joni Mayer
- Division of Health Promotion and Behavioral Sciences, School of Public Health, San Diego State University, San Diego, USA.,Institute for Behavioral and Community Health, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA, 92123, USA
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Johnson CM, Sharkey JR, Umstattd Meyer MR, Gómez L, Allicock MA, Prochnow T, Beltrán E, Martinez L. Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910117. [PMID: 34639420 PMCID: PMC8508574 DOI: 10.3390/ijerph181910117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022]
Abstract
Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.
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Affiliation(s)
- Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, San Marcos, TX 78666, USA
- Correspondence: ; Tel.: +1-(512)-245-9196
| | - Joseph R. Sharkey
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.R.S.); (L.G.); (E.B.); (L.M.)
| | - M. Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA;
| | - Luis Gómez
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.R.S.); (L.G.); (E.B.); (L.M.)
| | - Marlyn A. Allicock
- The University of Texas Health Science Center, Department of Health Promotion and Behavioral Sciences, Houston School of Public Health-Dallas Regional Campus, Dallas, TX 75207, USA;
| | - Tyler Prochnow
- Department of Health and Kinesiology, College of Education and Human Development, Texas A&M University, College Station, TX 77843, USA;
| | - Elva Beltrán
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.R.S.); (L.G.); (E.B.); (L.M.)
| | - Luz Martinez
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA; (J.R.S.); (L.G.); (E.B.); (L.M.)
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Kandula NR, Bernard V, Dave S, Ehrlich-Jones L, Counard C, Shah N, Kumar S, Rao G, Ackermann R, Spring B, Siddique J. The South Asian Healthy Lifestyle Intervention (SAHELI) trial: Protocol for a mixed-methods, hybrid effectiveness implementation trial for reducing cardiovascular risk in South Asians in the United States. Contemp Clin Trials 2020; 92:105995. [PMID: 32220632 PMCID: PMC8011000 DOI: 10.1016/j.cct.2020.105995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
Intensive lifestyle interventions targeting diet and physical activity are recommended for reducing atherosclerotic cardiovascular disease (ASCVD) risk in adults. However, existing interventions often do not reach immigrant populations because of a mismatch between the social, cultural, and environmental context of immigrants and Western bio behavioral models which underpin evidence-based lifestyle interventions. The South Asian Healthy Lifestyle Intervention (SAHELI) study is a type 1 hybrid design randomized controlled trial aimed at reducing ASCVD risk in South Asian Americans, a group at higher ASCVD risk than whites and other Asian Americans. The objective is to evaluate the clinical effectiveness and implementation potential of a community-based, culturally-adapted lifestyle intervention for South Asian adults. Participants (n = 550) will be randomized to printed healthy lifestyle education materials or SAHELI, a group-based lifestyle change program that includes weekly classes for 16 weeks and 4 booster classes though month 11. SAHELI integrates evidence-based behavior change strategies with culturally-adapted strategies and group motivational interviewing to improve diet, physical activity, and stress management. Follow-up assessments will occur at 6 and 12 months. We hypothesize that the SAHELI intervention group will have greater improvements in clinical ASCVD risk factors (weight, blood pressure, glycated hemoglobin, and lipids), physical activity, and psychosocial outcomes than the print material group at 6- and 12- months. We will use mixed-methods to examine SAHELI's potential for reach, adoption, implementation, and maintenance from the perspective of multiple stakeholders. This study offers the potential to increase the reach and effectiveness of evidence-based lifestyle interventions for South Asian adults at increased risk for ASCVD.
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Affiliation(s)
- Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States; Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Veronica Bernard
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Swapna Dave
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Linda Ehrlich-Jones
- Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, United States; Shirley Ryan AbilityLab, Chicago, IL, United States.
| | | | - Nirav Shah
- Northshore University HealthSystem, Skokie Hospital, Skokie, IL, United States.
| | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, United States.
| | - Goutham Rao
- Case Western Reserve University, Cleveland, OH, United States.
| | - Ronald Ackermann
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Bonnie Spring
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Juned Siddique
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
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St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Poggio R, Melendi SE, Beratarrechea A, Gibbons L, Mills KT, Chen CS, Nejamis A, Gulayin P, Santero M, Chen J, Rubinstein A, He J, Irazola V. Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight. Am J Prev Med 2019; 57:438-446. [PMID: 31473065 PMCID: PMC6755040 DOI: 10.1016/j.amepre.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01834131.
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Affiliation(s)
- Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Santiago E Melendi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Analía Nejamis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Tulane University Translational Science Institute, New Orleans, Louisiana; Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Soto SH, Arredondo EM, Shakya HB, Roesch S, Marcus B, Parada H, Ayala GX. Family environment, children's acculturation and mothers' dietary intake and behaviors among Latinas: An autoregressive cross-lagged study. Soc Sci Med 2019; 228:93-102. [PMID: 30897499 DOI: 10.1016/j.socscimed.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Many Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors. PURPOSE This longitudinal study examined the effect of the family environment on Latina mothers' dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children. METHODS Secondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested. RESULTS Less positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children. CONCLUSIONS Findings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.
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Affiliation(s)
- Sandra H Soto
- University of North Carolina, Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460 Chapel Hill, NC, 27599, USA.
| | - Elva M Arredondo
- Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA; San Diego State University, College of Health and Human Services, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, 5500 Campanile Drive, San Diego, CA, 92182, USA.
| | - Holly B Shakya
- University of California, San Diego, USA; Department of Medicine, Division of Global Health, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Scott Roesch
- San Diego State University, College of Sciences, Department of Psychology, 5500 Campanile Drive, San Diego, CA, 92182, USA.
| | - Bess Marcus
- Brown University, School of Public Health, 121 S Main St, Providence, RI, 02903, USA.
| | - Humberto Parada
- San Diego State University, College of Health and Human Services, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, 5500 Campanile Drive, San Diego, CA, 92182, USA.
| | - Guadalupe X Ayala
- Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA; San Diego State University, College of Health and Human Services, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, 5500 Campanile Drive, San Diego, CA, 92182, USA.
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14
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Arredondo EM, Ayala GX, Soto S, Slymen DJ, Horton LA, Parada H, Campbell N, Ibarra L, Engelberg M, Elder JP. Latina mothers as agents of change in children's eating habits: findings from the randomized controlled trial Entre Familia: Reflejos de Salud. Int J Behav Nutr Phys Act 2018; 15:95. [PMID: 30285755 PMCID: PMC6167856 DOI: 10.1186/s12966-018-0714-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/15/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Few children consume sufficient servings of fruits and vegetables. Interventions aiming to improve children's dietary intake often target parent level factors, but limited research has examined the mediating role of parental factors on children's dietary intake. This study examined 10-month follow up data from the Entre Familia: Reflejos de Salud (Within the Family: Reflections of Health) trial to investigate (1) intervention effects on children's dietary intake, both sustained and new changes, and (2) whether changes in mothers' dietary intake, her parenting strategies, and behavioral strategies to promoting healthy eating in the home mediated changes in children's dietary intake. METHODS Participants were 361 Mexican-origin families living in Imperial County, California. Families were randomly assigned to a 4-month dietary intervention or a delayed treatment control group. The intervention was delivered by promotoras (community health workers) via home visits and telephone calls. Assessments occurred at baseline, and 4- and 10-months post-baseline. RESULTS At 10-months post-baseline, sustained intervention effects were observed on children's reported intake of varieties of vegetables, with differences getting larger over time. However, differential intervention effects on fast food were not sustained due to significant reductions in the control group compared with smaller changes in the intervention group. New intervention effects were observed on servings of sugar-sweetened beverages. However, the intervention continued to have no effect on children's reported fruit and vegetable servings, and varieties of fruits consumed. Mother-reported behavioral strategies to increase fiber and lower fat mediated the relationship between the intervention and children's intake of varieties of vegetables. Mothers' percent energy from fat and behavioral strategies to lower fat were mediators of children's daily servings of sugar-sweetened beverages. CONCLUSIONS This study suggests that a promotora-led family based intervention can provide mothers with skills to promote modest changes in children's diet. Examining the parent related mechanisms of change will inform future interventions on important targets for improving children's diet. TRIAL REGISTRATION https://clinicaltrials.gov/ . NCT02441049 . Retrospectively registered 05.06.2015.
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Affiliation(s)
- Elva M Arredondo
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, 9245 Sky Park Ct., Suite 221, San Diego, CA, 92123, USA.
| | - Guadalupe X Ayala
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, 9245 Sky Park Ct., Suite 221, San Diego, CA, 92123, USA
| | - Sandra Soto
- School of Nursing, University of North Carolina, Carrington Hall, Campus Box #7460, Chapel Hill, NC, 97599, USA
| | - Donald J Slymen
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, 9245 Sky Park Ct., Suite 221, San Diego, CA, 92123, USA
| | - Lucy A Horton
- Institute for Behavioral and Community Health, 9245 Sky Park Ct, Suite 221, San Diego, CA, 92123, USA
| | - Humberto Parada
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Nadia Campbell
- Institute for Behavioral and Community Health, 9245 Sky Park Ct, Suite 221, San Diego, CA, 92123, USA
| | - Leticia Ibarra
- Clínicas de Salud del Pueblo, Inc., 1166 K Street, Brawley, CA, 92227, USA
| | - Moshe Engelberg
- Research Works, 12396 World Trade Dr #313, San Diego, CA, 92128, USA
| | - John P Elder
- Institute for Behavioral and Community Health, School of Public Health, San Diego State University, 9245 Sky Park Ct., Suite 221, San Diego, CA, 92123, USA
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Schmied EA, Chuang E, Madanat H, Moody J, Ibarra L, Ortiz K, Macias K, Ayala GX. A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program. Health Promot Pract 2018; 19:905-914. [PMID: 29448812 DOI: 10.1177/1524839918757487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.
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Affiliation(s)
- Emily A Schmied
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Hala Madanat
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Jamie Moody
- 4 University of California, San Diego, La Jolla, CA, USA
| | | | - Kenia Ortiz
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Karla Macias
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Guadalupe X Ayala
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
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Abstract
BACKGROUND Although breastfeeding is associated with proven benefits to both mother and child, there are many factors that influence a mother's decision to breastfeed. Pregnancy intentionality at the time of conception is associated with postpartum maternal behavior including breastfeeding. Research aim: We sought to understand how maternal and paternal pregnancy intentions were associated with breastfeeding initiation and duration in a nationally representative sample. METHODS We used a cross-sectional, retrospective study of the CDC National Survey of Family Growth data to examine the link between pregnancy intentionality and breastfeeding initiation and duration among women ages 15 to 44 years. RESULTS We found that whereas the mother's intention to have a child was a factor in how long she breastfed, the paternal intention to have a child predicted whether the mother breastfed at all. Additionally, Hispanic mothers were most likely to breastfeed and breastfed the longest of any other group. Age and education were also positive predictors of ever breastfeeding. CONCLUSION Understanding the father's and mother's attitudes toward the pregnancy and influence on breastfeeding intention is important for intervention planning.
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Affiliation(s)
- Shimrit Keddem
- 1 Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 VISN 4 Center for the Evaluation of Patient Aligned Care Teams, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rosemary Frasso
- 3 Master of Public Health Program, College of Population Health, Jefferson University, Philadelphia, PA, USA
| | - Melissa Dichter
- 4 Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,5 Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra Hanlon
- 6 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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17
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Horton LA, Ayala GX, Slymen DJ, Ibarra L, Hernandez E, Parada H, Rock CL, Arredondo EM, Elder JP. A Mediation Analysis of Mothers' Dietary Intake: The Entre Familia: Reflejos de Salud Randomized Controlled Trial. HEALTH EDUCATION & BEHAVIOR 2017; 45:501-510. [PMID: 29212358 DOI: 10.1177/1090198117742439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Examine intervention effects among mothers involved in a healthy eating randomized controlled trial. Furthermore, examine the mediating roles of individual and familial influences on observed outcomes. METHODS Between 2009 and 2011, 361 families were recruited; half were assigned to an 11-session community health worker-delivered family-based intervention targeting Spanish-speaking Latino families in Imperial County, California. The intervention was delivered over a 4-month period. Home visits and telephone calls were delivered approximately weekly, with tapering near the end of the intervention to promote independence from the promotora. In this article, mothers' self-reported dietary intake was the primary outcome. Evaluation measures were taken at baseline, 4 months, and 10 months. RESULTS Daily servings of fruits were higher among intervention versus control mothers (mean = 1.86 vs. mean = 1.47; effect size [ES] = 0.22) at 10 months post-baseline. Mothers in the intervention versus control condition also reported consuming a lower percent energy from fat (mean = 30.0% vs. 31.0%; ES = 0.30) and a higher diet quality (mean = 2.93 vs. mean = 2.67; ES = 0.29). Mediators of improvements were behavioral strategies to increase fiber and lower fat intake, family support for vegetable purchasing, and decreased unhealthy eating behaviors and perceived family barriers to healthy eating. DISCUSSION AND CONCLUSION Family-based behavioral interventions are effective for changing the skills and family system needed to improve diet among Latina mothers. Health care providers and other practitioners are encouraged to target skill development and fostering a socially supportive environment.
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Affiliation(s)
- Lucy A Horton
- 1 San Diego State University Research Foundation, San Diego, CA, USA
| | | | | | | | - Erika Hernandez
- 1 San Diego State University Research Foundation, San Diego, CA, USA
| | | | - Cheryl L Rock
- 4 University of California, San Diego, La Jolla, CA, USA
| | | | - John P Elder
- 2 San Diego State University, San Diego, CA, USA
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Chuang E, Brunner J, Moody J, Ibarra L, Hoyt H, McKenzie TL, Binggeli-Vallarta A, Cervantes G, Finlayson TL, Ayala GX. Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013. Prev Chronic Dis 2016; 13:E147. [PMID: 27763831 PMCID: PMC5072750 DOI: 10.5888/pcd13.160238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity. Methods A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized. Results Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community. Conclusion Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr South, Los Angeles, California 90095-1772.
| | - Julian Brunner
- Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - Jamie Moody
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | | | - Helina Hoyt
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | - Thomas L McKenzie
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | | | - Griselda Cervantes
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | - Tracy L Finlayson
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, Graduate School of Public Health, San Diego, California
| | - Guadalupe X Ayala
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, College of Health and Human Services, San Diego, California
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Schwingel A, Wiley AR, Teran-Garcia M, McCaffrey J, Gálvez P, Vizcarra M. Promotoras and the Semantic Gap Between Latino Community Health Researchers and Latino Communities. Health Promot Pract 2016; 18:444-453. [PMID: 27760810 DOI: 10.1177/1524839916670576] [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] [Indexed: 11/17/2022]
Abstract
Promotoras are identified as a unique group of community health workers adept at reducing health disparities. This qualitative study was conducted to better understand perceptions of the term promotora, broadly used in research but not well documented in everyday Latina vocabulary. Six focus groups to better understand perceptions of the term promotora were conducted with 36 Latina women living in three nonmetropolitan areas in Illinois. Results suggest that Latina participants in the study do not understand the meaning of "promotora" in the same way as it is used in the literature. Latina participants understood "promotoras" as referring to people who sell or deliver information, or organize events in the community that are not necessarily related to health events or community health work. Furthermore, they usually understood the term to refer to paid work rather than volunteering. Results underscore the importance of being sensitive to Latinas' perceptions of community health terminology by assessing their context, needs, and expectations. These findings call researchers' attention to the need to educate certain Latino communities about the concept of promotoras, with implications for the implementation and dissemination of promotora-led community health programs, as the semantic discrepancy could affect the recruitment of promotoras as well as community participation in the programs they deliver.
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Affiliation(s)
| | - Angela R Wiley
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Patricia Gálvez
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Marcela Vizcarra
- 1 University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Arcury TA, Skelton JA, Ip EH, Suerken CK, Trejo G, Quandt SA. Anticipatory Guidance about Child Diet and Physical Activity for Latino Farmworker Mothers. J Health Care Poor Underserved 2016; 27:1064-79. [PMID: 27524752 DOI: 10.1353/hpu.2016.0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND This analysis describes farmworker child health care utilization, anticipatory guidance for child weight, and the association of anticipatory guidance with personal characteristics, practice characteristics, and child's health care utilization. METHODS Data are from interviews conducted with 221 North Carolina Latino farmworker mothers with a child aged 4-5 years. RESULTS Half of the children were healthy weight, 19.0% were overweight, and 28.5% were obese. Most (56.4%) had been with the usual practice for two years or longer; most had well-child visits less frequently than once per year (71.5%). Fewer children with well-child visits than without were obese (14.8% vs. 35.5%; p=.01). More children with obesity than with healthy weight or overweight received guidance messages; more children without a well-child care visit in the past 12 months received guidance messages. CONCLUSIONS Health care providers are addressing anticipatory guidance when the opportunity arises. Creative approaches to address disparate primary care for farmworker families are important.
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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.
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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.
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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
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23
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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.
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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
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24
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Chuang E, Ayala GX, Schmied E, Ganter C, Gittelsohn J, Davison KK. Evaluation protocol to assess an integrated framework for the implementation of the Childhood Obesity Research Demonstration project at the California (CA-CORD) and Massachusetts (MA-CORD) sites. Child Obes 2015; 11:48-57. [PMID: 25423618 PMCID: PMC4323117 DOI: 10.1089/chi.2014.0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project. METHODS/DESIGN A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF. CONCLUSIONS Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
| | - Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
| | - Emily Schmied
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
- Department of Family and Preventive Medicine, University of California at San Diego School of Medicine, San Diego, CA
| | - Claudia Ganter
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Joel Gittelsohn
- Bloomberg School of Public Health and the Global Obesity Prevention Center, Johns Hopkins University, Baltimore, MD
| | - Kirsten K. Davison
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
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