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Dulin AJ, Dunsiger S, Benitez T, Larsen B, Marcus BH, Champion G, Gans KM. The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men. J Med Internet Res 2023; 25:e39310. [PMID: 38060285 PMCID: PMC10739242 DOI: 10.2196/39310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/14/2022] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men. OBJECTIVE This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis. METHODS We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message-based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months. RESULTS The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety. CONCLUSIONS The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease. TRIAL REGISTRATION ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23690.
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Affiliation(s)
- Akilah J Dulin
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | - Tanya Benitez
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | - Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Bess H Marcus
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | - Gregory Champion
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Kim M Gans
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
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Mattei J, Díaz-Alvarez CB, Alfonso C, O’Neill HJ, Ríos-Bedoya CF, Malik VS, Godoy-Vitorino F, Cheng C, Spiegelman D, Willett WC, Hu FB, Rodríguez-Orengo JF. Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet. Curr Dev Nutr 2023; 7:100022. [PMID: 37181130 PMCID: PMC10100940 DOI: 10.1016/j.cdnut.2022.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- FDI Clinical Research, San Juan, PR, USA
| | | | - Charmaine Alfonso
- College of Nutritionists and Dietitians of Puerto Rico, San Juan, PR, USA
- School of Health Sciences, Ana G. Méndez University, Gurabo Campus, Gurabo, PR, USA
| | - H June O’Neill
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Carlos F. Ríos-Bedoya
- FDI Clinical Research, San Juan, PR, USA
- McLaren Health Care, Graduate Medical Education, Grand Blanc, MI, USA
| | - Vasanti S. Malik
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutritional Sciences, University of Toronto, Ontario, Canada
| | - Filipa Godoy-Vitorino
- Department of Microbiology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Chao Cheng
- Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Donna Spiegelman
- Department of Biostatistics and Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Walter C. Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B. Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - José F. Rodríguez-Orengo
- FDI Clinical Research, San Juan, PR, USA
- Department of Biochemistry, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
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