Building a conceptual framework to culturally adapt health promotion and prevention programs at the deep structural level

Profiles of Cultural Adaptation and Parenting Approach for Childhood Obesity in Lifestyle Interventions for Families With Young Children: A Systematic Review

BACKGROUND AND OBJECTIVES

Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups.

METHODS

We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years).

RESULTS

Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation.

CONCLUSIONS

Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.

Deep-Structure Attitudes and Reasons Toward Healthy Eating and Self-Rated Diet and Health in Ethnically Diverse U.S.-Hispanics/Latinos

Little is known about deep-structure (i.e., embedded) cultural attitudes toward healthy eating among Hispanics/Latinos in the United States. This study aimed to identify ethnic-specific dietary attitudes of Latino adults and evaluate their associations with self-rated diet and health. Participants (n = 200) were community-based Latinos (25-65 y/o) living in the Boston, Massachusetts metro area who completed a survey assessing agreement with 20 statements on attitudes toward healthy eating (eight positive and 12 negative) and 15 statements on reasons for healthy eating across seven constructs. Multinomial logistic regression models tested the association of sum scores of positive or negative attitudes and reasons for healthy eating with self-rated diet or self-rated health for participants of Caribbean versus Non-Caribbean backgrounds. Most participants of both backgrounds agreed that healthy eating would keep them healthy and make them look good, and that families should eat together. Differences by background were noted in statements regarding eating at special occasions, cost of healthy foods, self-efficacy (i.e., cravings), and cultural beliefs. Negative attitudes were associated with lower odds of better self-rated health for Caribbean, but not for non-Caribbean, participants. Positive attitudes were associated with 1.85 (95% CI [1.10, 3.12]) odds of better self-rated diet for Caribbean participants and 3.13 (95% CI [1.26, 7.81]) for non-Caribbean participants. Non-Caribbean participants were more likely to self-rate very good/excellent diet with higher reasons for healthy eating. Latinos have shared and ethnic-specific deep-structure attitudes toward healthy eating related to their perceived diet quality and health. Programs promoting healthy eating for Latino adults should be deeply tailored by ethnicity.

Recommendations for Working with Culturally and Linguistically Diverse Families: A Report from the Field

Given the persistent shift in racial and ethnic demographics in the United States, board certified behavior analysts (BCBAs) will increasingly serve culturally and linguistically diverse families. There has been a recent increase in published resources to help behavior analysis practitioners navigate working with diverse populations. The purpose of this article is to add to these resources and demonstrate how these recommendations can be put into action. We outline five recommendations for working with culturally and linguistically diverse families in the context of a small company that has incorporated these practices in their own work focused on serving a large percentage of immigrant families.

Active bystandership by youth in the digital era: Microintervention strategies for responding to social media-based microaggressions and cyberbullying

Microaggressions are intentional or unintentional slights, insults, invalidations, and offensive behaviors that communicate hostile or derogatory messages to minoritized populations. When microaggressions cross over to social media, they can be considered a form of cyberbullying, which occurs over digital devices and harms, threatens, undermines, or socially excludes others. Microaggressions and cyberbullying have adverse mental health outcomes for racial and cultural minority youth, and there is an urgent need for practical strategies youth can use online to interrupt and disarm negative and harmful social media content. We used a multimethod approach to critically appraise and adapt Sue et al.'s (2019) microinterventions framework for use on social media with youth bystanders. Our analysis found high compatibility between microinterventions and youth bystander research, supporting transferability to social media for use with youth. Relevant adaptations include incorporating strategies that promote cognitive appraisal, cognitive empathy, education via social media, and use of social media features for external support. Using a social media microaggression example for each of the four microinterventions, we provide concrete tactics and example social media posts that youth can use when they come across insulting or offensive commentary online. The resulting framework offers a promising set of theory and research-informed strategies ready for further testing and refinement. When validated and refined, these microinterventions could be used as stand-alone strategies and/or incorporated into existing cyberbullying prevention or media literacy programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Etiologic mechanisms in an adapted family-based preventive intervention for underage alcohol use in Mexico: Results of an exploratory pilot study

Alcohol use represents a global health problem, especially for Latin American youth. As part of the Global Smart Drinking Goals campaign, a family-based preventive intervention was adapted and piloted in Mexico based on an existing evidence-based program, Guiding Good Choices. In this study, we explored the malleability and session-specific mean-level changes in protective and risk factors targeted by the adapted family intervention as related to the prevention of underage alcohol use and abuse. The sample consisted of 177 parents working at four private local companies who had children between the ages of 8 and 16. Data were collected before and after each program session. Linear mixed-effects models were used to examine growth trajectories and session-specific mean differences for selected etiologic factors. Significant effects on protective and risk factors were found. Among protective factors, positive family involvement showed the most considerable linear growth over time, while clear standards for youth showed the largest within-session increase. The greatest linear decrease in risk was observed for family conflict, which also showed the greatest pre-, and post-session reduction. Our findings suggest that the adapted program helped families develop protection against, and reduce risk of, alcohol use in their adolescent children. Results from this exploratory pilot study provide support for further rigorous evaluation and dissemination of the adapted intervention for Hispanic families.

Culturally adapting an evidence-based parenting intervention for the Chilean context: Balancing fidelity, context, and cultural relevance

The dissemination of evidence-based parent training (PT) interventions remains extremely limited in Latin American countries. This is concerning when considering the high prevalence of child maltreatment associated with punitive parenting practices across countries in the region. Furthermore, efforts to disseminate PT interventions must be conducted by adhering to the core parenting components that have established effectiveness for such interventions, while ensuring contextual and cultural relevance for focus populations. In this manuscript, we describe the cultural adaptation of an evidence-based PT intervention in the context of Chile. This initial phase of adaptation was informed by the theoretical tenets of the Ecological Validity Model of cultural adaptation (Bernal et al., J. Abnorm. Child Psychol., 23, 1995, 67). According to findings from a qualitative thematic analysis conducted with five interventionists in training, therapists perceived that the intervention's core components were relevant to Chilean caregivers who participated in the parenting program. Interventionists also provided specific suggestions to enhance the intervention's contextual and cultural relevance. This investigation illustrates the importance of culturally adapting evidence-based interventions according to comprehensive cultural adaptation frameworks, prior to engaging in large-scale dissemination of adapted interventions in Latin American contexts.

Couple-based lifestyle intervention to prevent type 2 diabetes: protocol for a randomised pilot trial

INTRODUCTION

Type 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals' social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants' romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT).

METHODS AND ANALYSIS

We used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, 'target individual') is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC's PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures.

ETHICS AND DISSEMINATION

This study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT.

TRIAL REGISTRATION NUMBER

NCT05695170.

Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet

Background

Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases.

Objectives

To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR).

Methods

The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome.

Results

PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication.

Conclusions

If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study

OBJECTIVE

The purpose of this study was to explore perceived ease of use, usability, and the feasibility of using mobile health applications to manage hypertension self-care in rural Black older adults with hypertension.

METHODS

A convergent parallel mixed method design was used to study a purposeful sample of 30 Black older adults (29 females, 1 male) from rural East Texas. Quantitative data included demographic characteristics and measured blood pressure, height, and weight, along with questionnaires: the Hill-Bone Compliance to High Blood Pressure Therapy Scale, the Krousel-Wood Medication Adherence Scale-4, and the Technology Acceptance Model Questionnaire (adapted). Qualitative data were obtained from five focus groups and analyzed using thematic analysis.

RESULTS

Mean age was 66.3 ± 9.6 years. Less than half of the participants (46.7%) had a systolic and/or diastolic blood pressure >130/80. Greater participant adherence was noted with the Hill-Bone Compliance scale (63.3%) than the Krousel-Wood scale (23.3%). With the Technology Acceptance Model, perceived ease of use was significantly correlated with behavioral intention (r = 0.654, p < 0.000) and perceived usefulness (r = 0.585, p < 0.001), while behavioral intention was negatively associated with age r = -0.047 (p=0.009). Focus group data revealed five themes: 1) useful, 2) counterintuitive, 3) communication, 4) comfort with the status quo, and 5) educate/show me how.

CONCLUSION

Smartphone technology and other health-related computer technologies were not preferred by older adults in this study due to limited digital literacy. Simplicity and easy navigation in the design of mHealth apps are needed to improve treatment adherence and blood pressure control in rural older adults with hypertension.

CLINICAL RELEVANCE

Mobile health applications have the potential to increase self-management of chronic hypertension if users are digitally literate. Health-care providers need to assess older patients for digital literacy and offer educational support and assistance.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019)

Racially and ethnically diverse and globally underserved populations continue to experience mental health disparities. The goal of this review was to examine the extent to which diverse populations were included in couple and family intervention research over the past decade and whether these studies were conducted with attention to issues of diversity. We performed a review of 271 articles reviewed in the current special issue on the efficacy and effectiveness of couple and family interventions across 11 mental health topics. Overall, only 68 of the 271 (25%) articles included predominately racial/ethnic minority samples or globally underserved populations. Among articles (n = 60) describing US-based research with racial/ethnic minority samples, there was a pattern of inattention to methodological considerations relevant to diverse populations. Although some progress was noted, more research is necessary. Specifically, we call for research that advances social justice by using critically conscious methods to promote mental health equity.

Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities

OBJECTIVE

While one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities.

METHODS

Through a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention.

RESULTS

This collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby.

IMPLICATIONS

Committing to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.

Cultural research deconstructs the psychosocial construct 'expressed emotion'

Expressed emotion (EE) is a highly researched psychosocial construct. Cultural research challenges the assumption that high family criticism is a universal determinant of poor outcome, especially for chronic illness. The concept of warmth, an original component of EE, was dropped owing to the complexity of its measurement. Warmth has now been resurrected as an important predictor of good patient outcome. Cultural scrutiny and appropriate adaptation of any psychosocial construct is necessary before its acceptance into the medical lexicon of healthcare.

Gaining insight into the implementation of an e-learning smoking cessation course in Latin American countries

Continuous medical education focused on health problems emerging in low- and middle-income countries (LMICs) is scarce. Although tobacco consumption is increasing in LMICs, there is a lack of tobacco cessation training programs in these countries. To promote smoking cessation interventions in Bolivia, Guatemala and Paraguay, we adapted an e-learning program developed in Catalonia (Spain). This process evaluation study reports on reach, dose and satisfaction of participants with the course, as well as the contextual factors of its application. We conducted a multiple method evaluation, which included a survey and several focus groups, each one specific to the same type of healthcare professional (nurses, doctors, other professionals). Two hundred and ninety-two participants registered into the online course. The motivation for undertaking the course was different between doctors and nurses. The main sources of difficulty in enrolling and finishing the course were the technical problems experienced when accessing the platform, and lack of acquaintance with computers and the Internet in general. Our results show that implementing e-learning education in hospitals from LMICs is feasible, especially when there are similarities between participating countries and the country in which the original program was developed. However, several elements such as strong organizational commitment, technical support and resources and adequate communication channels should be provided to facilitate enrollment and training completion. Efforts to improve Internet access should be made to avoid jeopardizing students' motivation to enroll and complete online training.

Health promotion in emerging collectivist communities: A study of dietary acculturation in the South Sudanese community in Logan City, Australia

Issue addressed

Understanding dietary acculturation within collectivist communities is required to develop and tailor appropriate health promotion strategies to prevent diet‐related chronic diseases. This research explores the journey of the South Sudanese community living in Logan City, Australia in establishing new norms around food choices and practices over time.

Methods

Three semi‐structured group interviews and a final community forum of women (n = 20) from the South Sudanese community were conducted. These explored changes in and influences on dietary practices post‐settlement. Sessions were recorded, transcribed and thematically analysed using inductive and deductive approaches. Feedback on findings from participants and community members was incorporated.

Results

Participants reported dietary acculturation phases, including assimilation, reflection and separation, with a return to traditional foods over time. Factors influencing the transition between phases included; the characteristics of the collectivist community such as shared knowledge, experiences and resources, increased accessibility to traditional foods, and increased food and health literacy as responses to emerging diet‐related health issues.

Conclusions

The Logan City South Sudanese community has navigated a new and complex food environment with positive long‐term dietary outcomes; however, the initial decline in health due to poor diet on arrival may have been prevented.

So what?

Early intervention and culturally appropriate health promotion strategies that are co‐designed and tailored to the characteristics and strengths of newly settled collectivist communities are needed. These should promote the benefits of healthy traditional food habits, while assisting communities to successfully navigate a new food environment.

Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review

BACKGROUND

This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants.

METHODS

Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups.

RESULTS

Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG).

CONCLUSIONS

This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families.

TRIAL REGISTRATION

The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).

Adapting evidence-informed complex population health interventions for new contexts: a systematic review of guidance

BACKGROUND

Adapting interventions that have worked elsewhere can save resources associated with developing new interventions for each specific context. While a developing body of evidence shows benefits of adapted interventions compared with interventions transported without adaptation, there are also examples of interventions which have been extensively adapted, yet have not worked in the new context. Decisions on when, to what extent, and how to adapt interventions therefore are not straightforward, particularly when conceptualising intervention effects as contingent upon contextual interactions in complex systems. No guidance currently addresses these questions comprehensively. To inform development of an overarching guidance on adaptation of complex population health interventions, this systematic review synthesises the content of the existing guidance papers.

METHODS

We searched for papers published between January 2000 and October 2018 in 7 bibliographic databases. We used citation tracking and contacted authors and experts to locate further papers. We double screened all the identified records. We extracted data into the following categories: descriptive information, key concepts and definitions, rationale for adaptation, aspects of adaptation, process of adaptation, evaluating and reporting adapted interventions. Data extraction was conducted independently by two reviewers, and retrieved data were synthesised thematically within pre-specified and emergent categories.

RESULTS

We retrieved 6694 unique records. Thirty-eight papers were included in the review representing 35 sources of guidance. Most papers were developed in the USA in the context of implementing evidence-informed interventions among different population groups within the country, such as minority populations. We found much agreement on how the papers defined key concepts, aims, and procedures of adaptation, including involvement of key stakeholders, but also identified gaps in scope, conceptualisation, and operationalisation in several categories.

CONCLUSIONS

Our review found limitations that should be addressed in future guidance on adaptation. Specifically, future guidance needs to be reflective of adaptations in the context of transferring interventions across countries, including macro- (e.g. national-) level interventions, better theorise the role of intervention mechanisms and contextual interactions in the replicability of effects and accordingly conceptualise key concepts, such as fidelity to intervention functions, and finally, suggest evidence-informed strategies for adaptation re-evaluation and reporting.

TRIAL REGISTRATION

PROSPERO 2018, CRD42018112714.

Alcohol consumption and consequences in adolescents in 68 low and middle-income countries - a multi-country comparison of risks by sex

AIMS

Alcohol use is a leading risk factor for disease burden among youth. This study estimated sex differences in the prevalence of alcohol use and consequences among adolescents living in low and middle-income countries (LMIC).

DESIGN

Multi-staged cross-sectional international standardized self-report questionnaires administered in the classroom.

SETTING

The Global school-based student health survey (GSHS) comprised adolescents from 68 LMIC between 2003-2014.

PARTICIPANTS

271,156 students aged 13-17 years old.

MEASUREMENTS

Alcohol measures included: past month alcohol consumption, history of intoxication and alcohol-related problems. Regions were based on the World Health Organization definitions: Africa, America, Eastern Mediterranean, Europe, South-east Asia, and Western Pacific.

FINDINGS

Overall, males had higher odds of alcohol use (OR = 2.38 [1.91-2.96]), a history of intoxication (OR = 2.64 [2.11-3.31]), and alcohol-related problems (OR = 1.72 [1.41-2.10]) than females. All regions recorded overall greater odds of alcohol use by males versus females; five regions (excluding Europe) recorded greater odds of intoxication in males; and three regions (America, South-east Asia, and Western Pacific) recorded greater odds of alcohol-related problems amongst males. However, there were country-level differences - in some countries, adolescent drinking rates and consequences were comparable by sex. Countries with the highest odds of alcohol use among males compared to females were Indonesia, Myanmar, Cambodia, Tuvalu, Morocco, Senegal, Kiribati, and Thailand.

CONCLUSIONS

Among adolescents living in LMIC, males had on average two-fold higher odds of drinking alcohol and experiencing adverse consequences. Growing affluence and improvements in sex equality in societies may increase the future prevalence of hazardous drinking in females in LMICs.

Confident and Understanding Parents (CUPs) - a child nutrition and active play pilot intervention for disadvantaged families attending Supported Playgroups in Victoria, Australia

ISSUE ADDRESSED

Health and nutrition inequalities are prevalent among families from socio-economically disadvantaged backgrounds. However, there is limited evidence of targeted early childhood nutrition and active play approaches due to the methodological challenges in engaging vulnerable families in research.

METHODS

The aim of this paper was to report findings from a pilot intervention called Confident and Understanding Parents (CUPs). CUPs aims to improve child nutrition and active play-related outcomes for children in vulnerable families. The intervention was delivered in six Supported Playgroups (SPs) in two disadvantaged locations in Victoria. Surveys incorporated knowledge and confidence measures and were administered pre- and post-training of SP facilitators along with pre-, immediately post and and 3 months postintervention to SP facilitators and parents. Qualitative data were collected via debriefing discussions with SP facilitators and ethnographic observations during SP sessions. Thematic analyses of qualitative data and statistical quantitative analyses were conducted.

RESULTS

Nine SP facilitators completed training, of whom six delivered CUPs in SPs with 64 parents of children aged 0 to 4 years from socially disadvantaged backgrounds. Forty-three parents (66%) attended a minimum of 50% of SP sessions with CUPs delivery. SP facilitators and parents demonstrated improved knowledge and confidence following the pilot. Learnings for implementation were identified.

CONCLUSION

Overall, the CUPs intervention reached and engaged vulnerable families. A strength of the intervention is the flexibility offered to SP facilitators in selecting key messages and the strong focus on "local" translation of key child nutrition and active play messages within existing early childhood settings. A further strength was the adaptation of evaluation methodology to optimise the engagement of vulnerable families. SO WHAT?: This pilot study provides insights about engaging vulnerable families in a nutrition and active play intervention to promote child health. These promising findings warrant further implementation and rigorous evaluation of CUPs.

Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study

BACKGROUND

Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients' smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries.

OBJECTIVE

The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay.

METHODS

This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants' attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training.

RESULTS

To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students' training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation.

CONCLUSIONS

There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies.

CLINICALTRIAL

Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2).

Exploratory Study of the Clinical Utility of the Pizzi Healthy Weight Management Assessment (PHWMA) Among Burmese High School Students

OBJECTIVE

Immigrant youth in the United States are at greater risk for weight management problems than non-Hispanic White youth. We used the Pizzi Healthy Weight Management Assessment (PHWMA) to capture data on health perceptions and weight management behaviors among adolescent Burmese refugees.

METHOD

We conducted a retrospective descriptive study of 20 Burmese refugee high school students.

RESULTS

The results captured an understanding of health perceptions and weight management behaviors of the program participants. The PHWMA was found to be a valid and reliable tool for use by occupational therapy practitioners.

CONCLUSION

Findings from this study can inform program development and evaluation in outreach efforts to enhance minority youths' health and well-being.

Older American Indians' Perspectives on Health, Arthritis, and Physical Activity: Implications for Adapting Evidence-Based Interventions, Oregon, 2013

Introduction

Despite the high prevalence of arthritis and physical disability among older American Indians, few evidence-based interventions that improve arthritis self-management via physical activity have been adapted for use in this population. The purpose of this study was to identify beliefs about health, arthritis, and physical activity among older American Indians living in a rural area in Oregon to help select and adapt an arthritis self-management program.

Methods

In partnership with a tribal health program, we conducted surveys, a focus group, and individual interviews with older American Indians with arthritis. Our sample comprised 6 focus group participants and 18 interviewees. The 24 participants were aged 48 to 82 years, of whom 67% were women. Forms B and C of the Multidimensional Health Locus of Control (MHLC) instrument, modified for arthritis, measured MHLC.

Results

The concepts of health, arthritis, and physical activity overlapped in that health was a holistic concept informed by cultural teachings that included living a healthy lifestyle, socializing, and being functionally independent. Arthritis inhibited health and healthy behaviors. Participants identified barriers such as unreliable transportation and recruiting challenges that would make existing interventions challenging to implement in this setting. The Doctor subscale had the highest MHLC (mean = 4.4 [standard deviation (SD), 1.0]), followed by the Internal subscale (3.9 [SD, 1.4]) and the Other People subscale (2.8 [SD, 1.1]).

Conclusions

Existing evidence-based programs for arthritis should be adapted to address implementation factors, such as access to transportation, and incorporate cultural values that emphasize holistic wellness and social interconnectedness. Culturally sensitive programs that build on indigenous values and practices to promote active coping strategies for older American Indians with arthritis are needed.