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Benitez TJ, Artigas E, Larsen B, Joseph RP, Pekmezi D, Marquez B, Whitworth JW, Marcus BH. Barriers and Facilitators to Muscle-Strengthening Activity Among Latinas in the U.S.: Results From Formative Research Assessments. Int J Behav Med 2024; 31:292-304. [PMID: 37231222 DOI: 10.1007/s12529-023-10183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Latinas are disproportionately affected by low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Few Latinas in the U.S. (17%) meet the National PA Guidelines for both aerobic PA and muscle-strengthening activity (MSA), yet, research to date in this population has focused almost exclusively on aerobic PA. Performing regular MSA is linked with numerous health improvements and reduced mortality; thus, may be key to addressing health disparities in this community. This study examined perspectives on engaging in MSA among Latinas enrolled in two aerobic PA RCTs. METHODS Brief quantitative surveys were conducted to assess interest in MSA among Latinas (N = 81), along with 19 follow-up in-depth semi-structured interviews on knowledge, barriers, and facilitators for engaging in regular MSA. Interview transcripts were analyzed by two independent bilingual researchers using a directed content analysis approach. RESULTS Eighty-one Latinas (18-65 years) completed the survey. Most (91%) expressed interest in learning more about MSA and 60% reported not knowing how to do MSA as a substantial MSA barrier. Interview results indicated Latinas were aware of health benefits of MSA and motivated to engage in MSA but reported barriers (e.g., perception that MSA is for men, a taboo topic, and lack of knowledge on how to do MSA). CONCLUSION This study contributes to a critical gap in PA research among Latinas. Findings will inform future culturally appropriate MSA interventions in this at-risk population. Addressing MSA and aerobic PA together in future interventions will provide a more comprehensive approach to reducing PA-related health disparities in Latinas than aerobic PA alone.
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Affiliation(s)
- Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.
| | - Eileen Artigas
- Center for Health Communication, University of Texas at Austin, Austin, TX, USA
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Rodney P Joseph
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Becky Marquez
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - James W Whitworth
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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Pekmezi D, Dunsiger S, Benitez T, Larsen B, Vasconez AM, Marcus B. Improvements in stress among Latinas participating in a randomized controlled trial of technology-supported physical activity interventions. Stress Health 2024:e3374. [PMID: 38289870 DOI: 10.1002/smi.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
High levels of stress and inactivity likely contribute to chronic disease disparities among Latinas in the U.S. and call for intervention. To inform such efforts, the current study examined the relationships among changes (over time) in physical activity, stress, and related cardiometabolic biomarkers among sedentary (mostly) first generation Latinas. Data are taken from a randomized controlled trial (N = 199 Latinas) of two home-based physical activity interventions (Original vs. theory- and technology- Enhanced versions). Physical activity and perceived stress were assessed at baseline and 6 and 12 months. Blood draws occurred at baseline and 6 months in a random subsample (N = 153). The participants were underactive (<60/min week of moderate-to-vigorous physical activity) Mexican American (89%) women with moderate perceived stress scores (M = 21.49, SD = 8.55, range = 0-40) and excess weight (M BMI = 30.6) at baseline. Overall, participants reported decreases in stress after 6 months enroled in the physical activity programs. The odds of a reduction in perceived stress were 11% higher among Enhanced versus Original Intervention participants (OR = 1.11, 95% CI: 1.05-2.27). Those who met physical activity guidelines were significantly more likely to report reductions in perceived stress over 6 months (OR = 1.92, 95% CI: 1.08-4.16). Furthermore, those who reported reductions in perceived stress over 6 months reported significantly more moderate-to-vigorous physical activity at 12 months (+69 min/week, SE = 27.98, p = 0.01) compared to those who did not. Greater reductions in perceived stress over 6 months were associated with greater improvements in cardiometabolic biomarkers (HbA1c, triglycerides, p's < 0.05). These results support a bidirectional relationship between improvements in stress and physical activity among Latinas. Future implications include using physical activity to address stress management and health disparities in this community.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA
| | - Andrea Mendoza Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
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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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Arevalo WM, Caicedo BI, Urizar GG, Schroeder J. Active Moms: a feasibility study of a community-based and home-based physical activity intervention for low-income, ethnic-minority mothers. Pilot Feasibility Stud 2023; 9:187. [PMID: 37978576 PMCID: PMC10655306 DOI: 10.1186/s40814-023-01378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Despite the health benefits of physical activity, increasing regular physical activity levels among low-income, ethnic-minority mothers has remained a significant challenge. Yet, few studies have examined the feasibility of implementing interventions to address physical activity barriers often experienced by this population. METHODS The current mixed-methods pilot study assessed the feasibility, impact, and acceptability of a 3-month community-based (CBI) and a home-based intervention (HBI) designed to improve physical activity and fitness levels, as well as psychosocial outcomes (self-efficacy and social support), among low-income, ethnic minority mothers. Mothers were randomized to either a 3-month CBI or HBI and completed pre- and post-intervention assessments of physical activity, fitness, self-efficacy, and social support. Intervention feasibility was assessed by tracking recruitment, retention, and adverse event rates, whereas intervention acceptability was assessed through post-intervention focus groups. RESULTS Although participant recruitment was lower than expected (30 vs. target of 52 mothers), retention and adverse event feasibility goals were met (> 60% retention rate, 0% adverse events). Mothers in both groups (CBI and HBI) showed significant improvements in their physical activity and fitness levels and short-term improvements in receiving social support for physical activity. However, only mothers in the CBI group showed improvements in their self-efficacy for physical activity. Mothers also reported both types of interventions (CBI and HBI) to be acceptable with minor modifications highlighted, including the potential for graduates of these programs to serve as group facilitators. CONCLUSIONS Overall, the study protocol was feasible, impactful, and acceptable to low-income, ethnic minority mothers with modifications required before large-scale evaluation. (TRN: NCT05540509; 9/12/22; retrospectively registered; ClinicalTrials.org).
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Affiliation(s)
- Wendy Miranda Arevalo
- Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Urban Planning, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Brianna Isabel Caicedo
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA
| | - Guido G Urizar
- Department of Psychology, California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840-0901, USA.
| | - Jan Schroeder
- Department of Kinesiology, California State University, Long Beach, Long Beach, CA, USA
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Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
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Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
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Larsen B, Gilmer T, Pekmezi D, Hartman SJ, Benitez T, Rabin B, Marcus BH, Mendoza-Vasconez AS, Groessl EJ. Cost effectiveness of a technology-enhanced physical activity intervention for Latinas. Transl Behav Med 2023; 13:675-682. [PMID: 37208924 PMCID: PMC10496433 DOI: 10.1093/tbm/ibad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, AL, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Borsika Rabin
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Erik J Groessl
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- Health Services Research and Development unit, VA San Diego Health Care System, San Diego, CA, USA
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Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non–/quasi-experimental trials. Prev Med Rep 2022; 29:101943. [PMID: 36161121 PMCID: PMC9502049 DOI: 10.1016/j.pmedr.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
The review evaluated internal and external validity using the rE-AIM Framework. Results indicate an overall low reporting of validity factors. Information on adoption and maintenance was particularly low. Future studies should improve the reporting across all rE-AIM dimensions. Future studies should consider adaptations during the implementation phase.
The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non–/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies. Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators. We included 39 studies of which 22 were non–/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non–/quasi-experimental trials. Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings. Trial registration: The review was registered with PROSPERO (CRD42021283688).
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Mendoza-Vasconez AS, Benitez T, Dunsiger S, Gans KM, Hartman SJ, Linke SE, Larsen BA, Pekmezi D, Marcus BH. Pasos Hacia La Salud II: study protocol for a randomized controlled trial of a theory- and technology-enhanced physical activity intervention for Latina women, compared to the original intervention. Trials 2022; 23:621. [PMID: 35915473 PMCID: PMC9341151 DOI: 10.1186/s13063-022-06575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background Latinas are at increased risk for many lifestyle-related chronic diseases and are one of the least physically active populations in the US Innovative strategies are needed to help Latinas achieve the health benefits associated with physical activity (PA). This manuscript describes the study protocol of the Pasos Hacia La Salud II Study, which builds upon our previous research to test an enhanced individually-tailored, text-message and website-delivered, Spanish-language intervention (enhanced intervention), in comparison to the original web-based Pasos Hacia La Salud Intervention (original intervention). Methods Sedentary Latinas between the ages of 18–65 will be recruited and will complete an orientation and baseline assessments. Participants will be subsequently randomized to the original intervention, or the Enhanced Intervention, which has greater targeting of theoretical constructs such as self-efficacy, enjoyment, and social support, and which uses text messages and more dynamic and refined website features to encourage increased website use. Using a linear mixed effects regression model, we will simultaneously estimate the intervention effects on mean accelerometer-measured hours/week of moderate-to-vigorous PA (MVPA) at 6, 12, 18, and 24 months, with a subject-specific intercept (intent-to-treat sample). Change in self-reported MVPA, measured via the 7-day Physical Activity Recall, will be assessed as a secondary outcome using a similar model. We will investigate potential mediators of the intervention effect using a multiple mediation approach, and potential moderators by evaluating potential interactions. As an exploratory outcome, we will study the differences (among both study arms) in cost, in US dollars, per minute increases in weekly mean MVPA. Discussion The original Pasos PA intervention showed efficacy in helping Latinas increase PA; we expect the Enhanced Intervention to help a larger proportion of participants to increase and maintain their PA long term. This web- and text-based enhanced intervention could have great reach and dissemination potential, which could be capitalized on in the future to help to advance health equity. Adaptations made in response to the COVID-19 pandemic are also described in this manuscript. Trial registration Clinical Trial Number: NCT03491592. First posted April 9, 2018.
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA.
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA.,Human Development and Family Sciences, College of Liberal Arts and Sciences, University of Connecticut, Storrs, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Sarah E Linke
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, USA
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Patnode CD, Redmond N, Iacocca MO, Henninger M. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:375-388. [PMID: 35881116 DOI: 10.1001/jama.2022.7408] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOMES AND MEASURES CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups. CONCLUSIONS AND RELEVANCE Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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10
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Benitez TJ, Dunsiger S, Marquez B, Larsen B, Pekmezi D, Marcus BH. Increases in Muscle-Strengthening Activities Among Latinas in Seamos Saludables. HEALTH EDUCATION & BEHAVIOR 2022; 49:446-454. [PMID: 35227112 DOI: 10.1177/10901981221074908] [Citation(s) in RCA: 1] [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
BACKGROUND Only 17% of Latinas meet national physical activity (PA) guidelines for both moderate-to-vigorous aerobic and muscle-strengthening PA. Additional health benefits are derived from the combination of aerobic and muscle-strengthening PA (vs. aerobic alone), yet there is paucity in research on muscle-strengthening activity in Latinas. The aim of this study was to examine changes in muscle-strengthening activity from baseline to 6 and 12 months in Seamos Saludables, a 12-month PA randomized controlled trial for Latinas. METHODS A secondary data analysis was conducted among 131 Latinas ages 18-65 years, who were randomized to either a PA Intervention or a Wellness Control. Self-reported muscle-strengthening exercise was measured at baseline, 6 months, and 12 months via adapted muscle-strengthening questions from the Behavioral Risk Factor Surveillance System. RESULTS There was a 16-minute/week difference in median minute/week of muscle-strengthening activity between Intervention and Wellness at 6 months (SE = 7.91, p = .04) and 45-minute/week difference at 12 months (SE = 25.80, p = .06) adjusting for baseline. Significantly more PA Intervention participants met muscle-strengthening guidelines of 2 or more days/week at 6 months versus Wellness Control participants (odds ratio [OR] = 4.29, 95% confidence interval [CI] = [1.03, 17.84]). CONCLUSION Results from the current study showed that Latinas engaged in muscle-strengthening activity in an intervention that emphasized primarily aerobic PA outcomes, suggesting they may be interested in engaging in muscle-strengthening activities. Future interventions targeting both aerobic and muscle-strengthening activity could achieve greater health improvements and help more Latinas reach the full national PA guidelines.ClinicalTrials.gov Identifier. NCT01583140.
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Affiliation(s)
- Tanya J Benitez
- Brown University School of Public Health, Providence, RI, USA
| | - Shira Dunsiger
- Brown University School of Public Health, Providence, RI, USA
| | - Becky Marquez
- University of California San Diego, La Jolla, CA, USA
| | - Britta Larsen
- University of California San Diego, La Jolla, CA, USA
| | - Dori Pekmezi
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bess H Marcus
- Brown University School of Public Health, Providence, RI, USA
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11
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Yeh PG, Reininger BM, Mitchell-Bennett LA, Lee M, Xu T, Davé AC, Park SK, Ochoa-Del Toro AG. Evaluating the Dissemination and Implementation of a Community Health Worker-Based Community Wide Campaign to Improve Fruit and Vegetable Intake and Physical Activity among Latinos along the U.S.-Mexico Border. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4514. [PMID: 35457382 PMCID: PMC9025101 DOI: 10.3390/ijerph19084514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
This study evaluated the dissemination and implementation of a culturally tailored community-wide campaign (CWC), Tu Salud ¡Si Cuenta! (TSSC), to augment fruit and vegetable (FV) consumption and physical activity (PA) engagement among low-income Latinos of Mexican descent living along the U.S.-Mexico Border in Texas. TSSC used longitudinal community health worker (CHW) home visits as a core vehicle to enact positive change across all socioecological levels to induce behavioral change. TSSC's reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) was examined. A dietary questionnaire and the Godin-Shepherd Exercise Questionnaire measured program effectiveness on mean daily FV consumption and weekly PA engagement, respectively. Participants were classified based on CHW home visits into "low exposure" (2-3 visits) and "high exposure" (4-5 visits) groups. The TSSC program reached low-income Latinos (n = 5686) across twelve locations. TSSC demonstrated effectiveness as, compared to the low exposure group, the high exposure group had a greater FV intake (mean difference = +0.65 FV servings daily, 95% CI: 0.53-0.77) and an increased PA (mean difference = +185.6 MET-minutes weekly, 95% CI: 105.9-265.4) from baseline to the last follow-up on a multivariable linear regression analysis. Multivariable logistic regression revealed that the high exposure group had higher odds of meeting both FV guidelines (adjusted odds ratio (AOR) = 2.03, 95% CI: 1.65-2.47) and PA guidelines (AOR = 1.36, 95% CI: 1.10-1.68) at the last follow-up. The program had a 92.3% adoption rate, with 58.3% of adopting communities meeting implementation fidelity, and 91.7% of communities maintaining TSSC. TSSC improved FV consumption and PA engagement behaviors among low-income Latinos region wide. CHW delivery and implementation funding positively influenced reach, effectiveness, adoption, and maintenance, while lack of qualified CHWs negatively impacted fidelity.
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Affiliation(s)
- Paul Gerardo Yeh
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
- Department of Physician Assistant, College of Health Professions, University of Texas Rio Grande Valley, 1201 West University Blvd., Edinburg, TX 78539, USA
- Postdoctoral Fellow, National Cancer Institute Cancer Control Research Training Program, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA
| | - Belinda M. Reininger
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
| | - Lisa A. Mitchell-Bennett
- Division of Health Promotion & Behavioral Sciences, Brownsville Regional Campus, School of Public Health, University of Texas Health Science Center, 80 Fort Brown, Brownsville, TX 78520, USA; (B.M.R.); (L.A.M.-B.)
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
| | - Minjae Lee
- Division of Biostatistics, Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA;
| | - Tianlin Xu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA; (T.X.); (S.K.P.)
| | - Amanda C. Davé
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
| | - Soo Kyung Park
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, 1200 Pressler Street, Houston, TX 77030, USA; (T.X.); (S.K.P.)
| | - Alma G. Ochoa-Del Toro
- Hispanic Health Research Center, School of Public Health, University of Texas Health Science Center, 1 West University Blvd., Brownsville, TX 78520, USA; (A.C.D.); (A.G.O.-D.T.)
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12
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Larsen B, Greenstadt E, Olesen B, Osuna L, Godino J, Marcus B, Dunsiger S, Meyer D, Zive M. A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes. Trials 2022; 23:176. [PMID: 35197106 PMCID: PMC8864594 DOI: 10.1186/s13063-022-06105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents. Methods We plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time. Discussion The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination. Trial registration ClinicalTrials.govNCT04190225. Registered on November 20, 2019
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA.
| | - Emily Greenstadt
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA
| | - Brittany Olesen
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA
| | - Lilliana Osuna
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA
| | - Job Godino
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA.,Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Dawn Meyer
- Department of Neurosciences, School of Medicine, UC San Diego, La Jolla, CA, USA
| | - Michelle Zive
- Herbert Wertheim School of Public Health & Human Longevity Science, UC San Diego, La Jolla, CA, USA
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13
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El Masri A, Kolt GS, George ES. Physical activity interventions among culturally and linguistically diverse populations: a systematic review. ETHNICITY & HEALTH 2022; 27:40-60. [PMID: 31446773 DOI: 10.1080/13557858.2019.1658183] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions. DESIGN Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18). RESULTS A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material. CONCLUSIONS Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention.
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Affiliation(s)
- Aymen El Masri
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Gregory S Kolt
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Emma S George
- School of Science and Health, Western Sydney University, Sydney, Australia
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14
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Marcus BH, Larsen BA, Linke SE, Hartman SJ, Pekmezi D, Benitez T, Sallis J, Mendoza-Vasconez AS, Dunsiger SI. Long-term physical activity outcomes in the Seamos Activas II trial. Prev Med Rep 2021; 24:101628. [PMID: 34976681 PMCID: PMC8684003 DOI: 10.1016/j.pmedr.2021.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 10/27/2022] Open
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15
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Physical activity outcomes from a randomized trial of a theory- and technology-enhanced intervention for Latinas: the Seamos Activas II study. J Behav Med 2021; 45:1-13. [PMID: 34379236 DOI: 10.1007/s10865-021-00246-6] [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: 03/01/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
Latina women report disproportionately high and increasing prevalence of chronic health conditions (obesity, diabetes) related to low physical activity levels. Efforts to date at addressing high rates of physical inactivity in this at-risk population have shown modest success. The original Seamos Saludables (sample size N = 266) was a culturally and linguistically adapted, print-based physical activity intervention that showed significant increases in moderate to vigorous physical activity (MVPA) from baseline to 6 months. However, only 11% of intervention participants reached the national PA guidelines of ≥ 150 min/week of aerobic MVPA. The current study tests the original Seamos Saludables intervention (Original Intervention) against an enhanced iteration Seamos Activas II (Enhanced Intervention). Study aims and intervention refinements focus on increasing the percentage of Latinas meeting national aerobic PA guidelines. For the current study (Seamos Activas II), a randomized controlled trial with (N = 199 participants) of two PA interventions (original intervention, N = 102; vs. enhanced intervention, N = 97) was conducted. Intervention refinements involved further targeting key constructs of the Social Cognitive Theory and incorporating text-message-based strategies for self-monitoring, in response to participant feedback for greater interactivity and accountability. PA assessments were conducted at baseline and 6 months. The sample was predominantly Mexican American (89%) with average age of 43.8 years (SD = 10.11) and mean BMI at baseline was 30.6 (SD = 7.56). There were significant within group increases in MVPA from baseline to 6 months (p < .05) in both Original and Enhanced Intervention arms. However, quantile regression models did not indicate significant differences in 6-month outcomes between conditions controlling for baseline, p = 0.73. There were significant differences between conditions with respect to meeting national guidelines for aerobic MVPA at 6 months, with 57% of Enhanced Intervention participants meeting guidelines compared to 44% of Original Intervention participants, OR = 1.66, 95% CI: 1.09 -2.89. Models suggest trends favoring the enhanced condition for improvements in biomarkers over 6 months. Findings indicate that the intervention enhancements likely helped more Latinas achieve nationally recommended, health enhancing PA levels than the original intervention and showed promise for improving physiological response to exercise.Trial Registration ClinicalTrials.Gov; NCT02630953. Registered 14 December 2015. https://clinicaltrials.gov/ct2/show/NCT02630953 .
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16
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Gans KM, Dulin A, Palomo V, Benitez T, Dunsiger S, Dionne L, Champion G, Edgar R, Marcus B. A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial. JMIR Res Protoc 2021; 10:e23690. [PMID: 33512327 PMCID: PMC7880809 DOI: 10.2196/23690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Abstract
Background Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men. Objective To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables. Methods Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization. Results This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing. Conclusions We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial. Trial Registration Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID) DERR1-10.2196/23690
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Affiliation(s)
- Kim M Gans
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States.,Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Akilah Dulin
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Vanessa Palomo
- Cardiovascular Center for Research and Innovation, Tufts University Medical Center, Boston, MA, United States
| | - Tanya Benitez
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Shira Dunsiger
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laura Dionne
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Gregory Champion
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Rachelle Edgar
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Bess Marcus
- Department of Behavioral And Social Sciences, Brown University School of Public Health, Providence, RI, United States
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17
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Mendoza-Vasconez AS, Arredondo EM, Larsen B, Crespo N, Hurst S, Marcus BH. Lapse, Relapse, and Recovery in Physical Activity Interventions for Latinas: a Survival Analysis. Int J Behav Med 2021; 28:540-551. [PMID: 33415695 DOI: 10.1007/s12529-020-09943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physical activity (PA) research extensively focuses on initiation of PA, yet lapse and relapse among PA intervention participants are less well understood, particularly among minority populations such as Latinas in the USA. This study aimed to (1) determine the probability of lapse during two PA interventions for Latinas; (2) assess demographic, psychosocial, and environmental predictors of the amount of time until first lapse; and (3) identify factors predictive of lapse recovery. METHODS Data from 176 Latina intervention participants were pooled. Survival functions and Kaplan-Meier curves were used to illustrate probability of lapse. Cox proportional hazard models assessed predictors of time to lapse. Logistic regressions identified predictors of lapse recovery. RESULTS The probability of lapse after 1 month of starting to exercise was 18%, escalating to 34% after 4 months. Predictors of earlier lapse included various psychosocial constructs (i.e., self-efficacy and various processes of change), but none of the measured environmental factors, and only one demographic factor (≥ 2 children under 18). Increased use of consciousness raising at 2 months was associated with lower likelihood of lapse recovery, yet use of behavioral processes of change at 6 months was associated with higher likelihood of recovery. CONCLUSIONS Lapsing may not be pre-determined by demographic and environmental characteristics. On the other hand, skills that can be learned through interventions, such as skills to improve self-efficacy, seem important in the delay or prevention of lapses. Results pertaining to lapse recovery are less clear.
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- Stanford Prevention Research Center, Stanford University, 1265 Welch Rd, Palo Alto, CA, 94305, USA. .,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA. .,Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA.
| | - Elva M Arredondo
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Britta Larsen
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
| | - Noe Crespo
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Samantha Hurst
- Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0725, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121, South Main Street, Providence, Rhode Island, 02903, USA
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18
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Larsen B, Dunsiger SI, Pekmezi D, Linke S, Hartman SJ, Marcus BH. Psychosocial mediators of physical activity change in a web-based intervention for Latinas. Health Psychol 2020; 40:21-29. [PMID: 33370154 DOI: 10.1037/hea0001041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: To determine whether psychosocial constructs targeted in an online physical activity intervention for Latinas mediated changes in moderate-to-vigorous physical activity (MVPA). Method: Data were taken from a randomized trial of a web-based MVPA intervention for Latina women age 18-65 (N = 205) based on social cognitive theory and the transtheoretical model. Baseline and 6-month measures included minutes/week of MVPA (ActiGraph GT3X + accelerometers and 7-Day Physical Activity Recall Interview) and theorized mediators (self-efficacy, behavioral processes, cognitive processes, social support, enjoyment). A multiple mediation model adjusting for baseline MVPA was fit using a products of coefficients method, simultaneously testing all hypothesized mediators. Results: MVPA increased more in the intervention group than controls by 50 min/week (self-report) and 31 min/week (accelerometers). For the self-reported MVPA model, there was an intervention effect (a-path coefficient) on self-efficacy (b = 0.43, p < .01), cognitive processes (b = 0.64, p < .01), behavioral processes (b = 0.54, p < .01), and enjoyment (b = 9.91, p = .01). Changes in self-efficacy (b = 24.54, p = .03), social support from friends (b = 2.36, p = .04), and enjoyment (a = 0.74, p = .08) were associated with changes in MVPA (b-path coefficient). However, only changes in self-efficacy (b = 10.49, 95% CI [2.46, 24.54]) and enjoyment (b = 7.30, 95% CI [0.92, 21.78]) mediated the intervention effect on MVPA (ab-path coefficient). For the accelerometer-measured MVPA model, intervention effects were significant for self-efficacy (b = 0.48, p < .01), cognitive processes (b = 0.62, p < .01), and behavioral processes (b = 0.61, p < .01), yet only self-efficacy was associated with changes in MVPA (b = 4.43, p = .03), and mediated intervention effects on MVPA (b = 12.15, 95% CI [11.25, 16.34]). Conclusions: Future MVPA interventions with Latinas should target self-efficacy and enjoyment to maximize efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham
| | - Sarah Linke
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
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19
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Larsen B, Micucci S, Hartman SJ, Ramos G. Feasibility and Acceptability of a Counseling- and mHealth-Based Physical Activity Intervention for Pregnant Women With Diabetes: The Fit for Two Pilot Study. JMIR Mhealth Uhealth 2020; 8:e18915. [PMID: 33084584 PMCID: PMC7641781 DOI: 10.2196/18915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/06/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetes during pregnancy poses serious health risks to both mother and child. Regular physical activity can reduce these risks, yet few clinic-based interventions of physical activity for pregnant women with diabetes have been attempted. OBJECTIVE The purpose of this single-arm pilot trial is to assess the feasibility and acceptability, and explore the potential efficacy of a counseling- and mobile health-based physical activity intervention for pregnant women with diabetes. METHODS Participants (N=17) who had type 2 or gestational diabetes, could read and speak in English or Spanish, and were between 10 and 27 weeks of gestation were recruited from the University of California San Diego Diabetes and Pregnancy Program. Participants engaged in a one-on-one counseling and goal-setting session immediately following a clinic visit with their physician. They were given a Fitbit and shown how to use the Fitbit app, including entering personalized step goals, and were encouraged to build up to 10,000 daily steps. Daily steps were recorded for 12 weeks, until they were 36 weeks' gestation, or until 1 week before they gave birth, whichever came first. Feasibility was measured by recruitment, retention, and adherence, and acceptability was measured using consumer satisfaction questionnaires and follow-up interviews. Potential efficacy was explored by examining changes in daily steps over time. RESULTS The participants were primarily Hispanic (13/17, 76%), had public insurance (15/17, 88%), and had type 2 diabetes (12/17, 71%). Of the 17 patients who began the intervention, 76% (13/17) completed a follow-up visit, and 71% (12/17) continued wearing the Fitbit regularly after 8 weeks in the intervention. Adherence in wearing the Fitbit was relatively high, with a median wear adherence of 90% of days. The intervention was generally well accepted, with 85% (11/13) indicating that they were motivated to exercise more following the counseling session, 85% (11/13) indicating that the Fitbit helped increase their activity, and 92% (12/13) recommending the program overall. Mean daily steps increased from baseline (mean 6122, SD 2439) to week 3 (mean 6269, SD 2166) and then decreased through week 12 (mean 4191, SD 2228). CONCLUSIONS High acceptability, retention, and adherence suggest that this may be a promising approach to delivering a simple, low-burden intervention in a clinical setting to a high-risk, underserved population. A randomized controlled trial is needed to determine whether this approach is effective in slowing the reduction in activity typically seen throughout pregnancy. TRIAL REGISTRATION ClinicalTrials.gov NCT03302377; https://clinicaltrials.gov/ct2/show/NCT03302377.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Stephanie Micucci
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Sheri J Hartman
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Gladys Ramos
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, CA, United States
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20
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Larsen BA, Benitez TJ, Mendoza-Vasconez AS, Hartman SJ, Linke SE, Pekmezi DJ, Dunsiger SI, Nodora JN, Gans KM, Marcus BH. Randomized Trial of a Physical Activity Intervention for Latino Men: Activo. Am J Prev Med 2020; 59:219-227. [PMID: 32448552 PMCID: PMC7375921 DOI: 10.1016/j.amepre.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Latino men experience disproportionately high rates of diseases related to low physical activity, yet they are poorly represented in physical activity intervention trials. Efforts to promote physical activity in Latina women show promising results, yet such interventions are yet to be extended to Latino men. This study tested a computer expert system‒tailored, text messaging-supported physical activity intervention for underactive Spanish-speaking Latino men compared with a control group matched for contact time. Potential predictors of intervention success were also explored. STUDY DESIGN Randomized trial. Participants were randomized to receive a Tailored Physical Activity Intervention (Intervention) or a Wellness Control (Control). Data were collected in 2015-2017 and analyzed in 2018-2019. SETTING/PARTICIPANTS Insufficiently active Latino men (n=46). INTERVENTION Intervention participants received a baseline counseling session and then, individually tailored print materials and text messages on a tapered schedule for 6 months. Control participants received printed wellness materials and text messages on the same schedule. MAIN OUTCOME MEASURES Primary outcome was a change in weekly moderate to vigorous physical activity from baseline to 6 months measured by accelerometers. Self-reported moderate to vigorous physical activity measured by the 7-day Physical Activity Recall Interview was a secondary outcome. RESULTS For Intervention participants, median accelerometer-measured moderate to vigorous physical activity increased from 10.0 minutes/week at baseline to 57.5 minutes/week at 6 months, whereas for Control participants, it increased from 21.0 minutes/week at baseline to 23.0 minutes/week at 6 months (p<0.05). Similar results were found for self-reported moderate to vigorous physical activity. At 6 months, 47% of Intervention participants met national guidelines of 150 minutes/week versus 25% of Control participants (p=0.15, not significant). CONCLUSIONS Findings suggest that an individually tailored intervention can successfully increase moderate to vigorous physical activity in underactive Latino men. Such technology-supported interventions have the potential for broad dissemination. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02512419.
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Affiliation(s)
- Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
| | - Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Andrea S Mendoza-Vasconez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Sarah E Linke
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Dori J Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, Alabama
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, Rhode Island
| | - Jesse N Nodora
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
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21
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Benitez TJ, Dunsiger SI, Pekmezi DJ, Larsen BA, Mendoza-Vasconez AS, Linke SE, Bock BC, Gans KM, Hartman SJ, Marcus BH. Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study. Contemp Clin Trials 2020; 96:106081. [PMID: 32687974 DOI: 10.1016/j.cct.2020.106081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention. METHODS/DESIGN The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings. RESULTS Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change. CONCLUSION Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.
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Affiliation(s)
- Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Dori J Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Britta A Larsen
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | | | - Sarah E Linke
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Beth C Bock
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America; Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, United States of America
| | - Sheri J Hartman
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
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22
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Physical Activity Intervention Effects on Sedentary Time in Spanish-Speaking Latinas. J Phys Act Health 2020; 17:343-348. [PMID: 32035412 DOI: 10.1123/jpah.2019-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 11/13/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Latinas have high rates of sedentary behavior and related health disparities, but it is unknown if interventions to increase physical activity will also reduce sedentary time. The current study examined changes in objectively measured sedentary time among Latinas in a randomized controlled trial of a physical activity intervention. METHODS Spanish-speaking Latinas (N = 202) were randomized to an exercise or wellness group and wore an accelerometer at baseline, 6 months, and 12 months. RESULTS Participants were sedentary on an average of 8.86 hours per day (SD = 2.60) at baseline. The intervention group had significantly greater increases in sedentary time compared with the control group, with the intervention group engaging in 146 more minutes per week of sedentary time at 6 months and 254 minutes per week of sedentary time at 12 months than the control group (P = .02). The intervention effect on sedentary behavior remained after controlling for moderate to vigorous physical activity. Additionally, time spent in moderate to vigorous physical activity was positively associated with more sedentary time (P = .04). CONCLUSION An intervention to increase moderate to vigorous physical activity resulted in greater sedentary time, raising concerns regarding compensation and highlighting the need for interventions to address both physical activity and sedentary behavior to improve public health.
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23
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Murray JM, Brennan SF, French DP, Patterson CC, Kee F, Hunter RF. Mediators of Behavior Change Maintenance in Physical Activity Interventions for Young and Middle-Aged Adults: A Systematic Review. Ann Behav Med 2019; 52:513-529. [PMID: 29672666 DOI: 10.1093/abm/kay012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Regular physical activity is important for maintaining physical and mental health. Benefits are optimized when physical activity is maintained. Understanding causal mechanisms is important to inform future interventions. Purpose To investigate mediators of physical activity maintenance. Methods Six databases were searched (Medline, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Web of Science). Eligibility criteria included adult nonclinical populations, validated measure of physical activity behavior at baseline and at least 6 months postbaseline, control/comparison group(s), and reported mediators of physical activity behavior change. Mediators were examined according to (i) formal mediation tests, (ii) mediator association with physical activity outcome, and (iii) intervention effects on mediators. Results There were few formal mediation tests conducted (n = 12/39 included studies), and various other methodological limitations were identified. There was some evidence that effective mediators in formal mediation tests at 6 months and later included the "behavioral processes of change" (n = 5/6). Many of the included interventions were not effective for changing targeted mediators (only 34% of 413 tests of mediator changes were significant). Conclusions There were a number of methodological and statistical limitations in the evidence base. In future, prespecified formal mediation tests should be carried out and could be aided by a formal framework. Social and environmental variables should be considered in addition to intrapersonal variables. Improving knowledge of how to change hypothesized mediators, based on theory and evidence, will reveal how physical activity behavior change maintenance can be achieved. Maintenance research would be enhanced by establishing a formal definition of behavior change "maintenance." PROSPERO registration: PROSPERO 2015:CRD- 42015025462.
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Affiliation(s)
- Jennifer M Murray
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Sarah F Brennan
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - David P French
- Department for Health Psychology, Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher C Patterson
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Frank Kee
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
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24
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Mabweazara SZ, Leach LL, Ley C. Development of a context-sensitive physical activity intervention for persons living with HIV and AIDS of low socioeconomic status using the behaviour change wheel. BMC Public Health 2019; 19:774. [PMID: 31208375 PMCID: PMC6580554 DOI: 10.1186/s12889-019-7091-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background Regular physical activity (PA) has been recommended for the management of HIV and AIDS. The purpose of this study was to develop a contextualised intervention for promoting PA among women living with HIV and AIDS (WLWHA) of low socioeconomic status (SES). A secondary aim of the study was to optimise the PA intervention using behavioural theory/ frameworks derived from preliminary studies and the literature. Methods The Behaviour Change Wheel (BCW) for designing behaviour change interventions was used. This method was further supplemented by evidence from the literature, systematic literature review (SLR), a concurrent mixed methods study and two cross-sectional studies. The SLR aided in determining the theoretical frameworks to inform the intervention, the specific PA behaviours to be targeted by the intervention, the intervention functions, the intervention policy category and the mode of delivery of the intervention. The concurrent mixed methods study was used to identify key factors that needed to change in order for participants to engage in regular PA. The first cross-sectional study was used to determine the gender to be targeted by the study. The second cross-sectional study was used to determine the domain and intensity of PA to target in the intervention. Results A face-to-face context-sensitive PA intervention employing 14 behavioural change techniques was designed. The PA intervention (a) utilised the Transtheoretical model of behaviour change and the Social Cognitive theory as the underpinning theoretical frameworks (b) included convenient PAs, such as walking, doing simple home-based exercises, engaging in activities of daily living or doing simple exercises at the community centre (c) used education, reward, training in PA, modelling exercise activities and enablement to increase the opportunity to engage in PA as intervention functions (d) used service provision as policy priorities, and (e) used a direct face-to-face mode of delivery. Conclusions The PA intervention emphasises behavioural techniques for increasing PA participation, such as goal-setting, self-monitoring, strategies for overcoming PA barriers, social support and rewards. The intervention employs strategies that highlight low-cost local PA resources and opportunities to help HIV infected women of low SES to participate in PA. The BCW provides a useful and comprehensive framework for the development of evidence and theory-based PA interventions for PLWHA of low SES. The BCW can thus be used in the development of interventions that ‘talk’ to policy by bridging the health inequality gap.
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Affiliation(s)
- S Z Mabweazara
- Department of Sport, Recreation & Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - L L Leach
- Department of Sport, Recreation & Exercise Science, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - C Ley
- Institute of Sport Science, University of Vienna, Auf der Schmelz 6, 1150, Vienna, Austria. .,Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria.
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25
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Mendoza-Vasconez AS, Marquez B, Linke S, Arredondo EM, Marcus BH. Effect of Physical Activity on Depression Symptoms and Perceived Stress in Latinas: A Mediation Analysis. Ment Health Phys Act 2019; 16:31-37. [PMID: 31853264 PMCID: PMC6919653 DOI: 10.1016/j.mhpa.2019.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea S. Mendoza-Vasconez
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, San Diego, CA 92093-0725 USA
- Graduate School of Public Health, San Diego State University, San Diego 5500 Campanile Dr, San Diego, CA 92182 USA
| | - Becky Marquez
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, San Diego, CA 92093-0725 USA
| | - Sarah Linke
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, San Diego, CA 92093-0725 USA
| | - Elva M. Arredondo
- Graduate School of Public Health, San Diego State University, San Diego 5500 Campanile Dr, San Diego, CA 92182 USA
| | - Bess H. Marcus
- Department of Family Medicine & Public Health, University of California, San Diego 9500 Gilman Drive, San Diego, CA 92093-0725 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, Rhode Island 02903 USA
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26
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Bull ER, McCleary N, Li X, Dombrowski SU, Dusseldorp E, Johnston M. Interventions to Promote Healthy Eating, Physical Activity and Smoking in Low-Income Groups: a Systematic Review with Meta-Analysis of Behavior Change Techniques and Delivery/Context. Int J Behav Med 2018; 25:605-616. [PMID: 30003476 PMCID: PMC6244564 DOI: 10.1007/s12529-018-9734-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Healthy eating, physical activity and smoking interventions for low-income groups may have small, positive effects. Identifying effective intervention components could guide intervention development. This study investigated which content and delivery components of interventions were associated with increased healthy behavior in randomised controlled trials (RCTs) for low-income adults. METHOD Data from a review showing intervention effects in 35 RCTs containing 45 interventions with 17,000 participants were analysed to assess associations with behavior change techniques (BCTs) and delivery/context components from the template for intervention description and replication (TIDieR) checklist. The associations of 46 BCTs and 14 delivery/context components with behavior change (measures of healthy eating, physical activity and smoking cessation) were examined using random effects subgroup meta-analyses. Synergistic effects of components were examined using classification and regression trees (meta-CART) analyses based on both fixed and random effects assumptions. RESULTS For healthy eating, self-monitoring, delivery through personal contact, and targeting multiple behaviors were associated with increased effectiveness. Providing feedback, information about emotional consequences, or using prompts and cues were associated with reduced effectiveness. In synergistic analyses, interventions were most effective without feedback, or with self-monitoring excluding feedback. More effective physical activity interventions included behavioral practice/rehearsal or instruction, focussed solely on physical activity or took place in home/community settings. Information about antecedents was associated with reduced effectiveness. In synergistic analyses, interventions were most effective in home/community settings with instruction. No associations were identified for smoking. CONCLUSION This study identified BCTs and delivery/context components, individually and synergistically, linked to increased and reduced effectiveness of healthy eating and physical activity interventions. The identified components should be subject to further experimental study to help inform the development effective behavior change interventions for low-income groups to reduce health inequalities.
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Affiliation(s)
- Eleanor R Bull
- Manchester Metropolitan University, Manchester, UK.
- University of Manchester, Manchester, UK.
| | | | - Xinru Li
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | | | - Elise Dusseldorp
- Institute of Psychology, Leiden University, Leiden, the Netherlands
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27
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Loya JC. Systematic Review of Physical Activity Interventions in Hispanic Adults. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:174-188. [PMID: 30474403 DOI: 10.1177/1540415318809427] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Physical activity (PA) has demonstrated substantial physical and psychological benefits. However, Hispanics engage in less leisure-time PA when compared with other groups, putting them at higher risk for diseases associated with obesity, such as diabetes mellitus type 2. This literature review was conducted to identify best practices with regard to interventions designed to increase PA among Hispanic adults. METHODS Extensive searching located 21 randomized controlled studies conducted in the United States. RESULTS Common conceptual frameworks were the transtheoretical model and social cognitive theory. Most interventions used educational sessions with a variety of topics and many used promotoras to increase PA. Outcomes were predominantly examined using self-report PA measures. Walking was the most commonly reported PA behavior. Studies with significant results were those that measured moderate-to-vigorous PA and used theory to guide interventions. Male and older participants were underrepresented. CONCLUSIONS Effective culturally appropriate PA interventions for Hispanics adults are needed. Particular attention to intervention tailoring based on country of origin could enhance intervention effectiveness.
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Cotie LM, Prince SA, Elliott CG, Ziss MC, McDonnell LA, Mullen KA, Hiremath S, Pipe AL, Reid RD, Reed JL. The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis. Obes Rev 2018; 19:1340-1358. [PMID: 30156044 DOI: 10.1111/obr.12700] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/25/2022]
Abstract
Physical inactivity and obesity are modifiable risk factors for cardiovascular disease, particularly in women. eHealth interventions may increase physical activity and improve obesity-related outcomes among women. The objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous physical activity among working-age women. The secondary objective was to examine their effectiveness on improving obesity-related outcomes. A comprehensive search strategy was developed for eight electronic databases; through July 2016. All studies consisting of >80% women of working-age (18-65 years) in high income countries were included. Multiple unblinded reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and data quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model. Sixty studies were included in the review of which 20 were in the meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous physical activity (standard mean difference = 1.13, 95% confidence interval: 0.58, 1.68, P < 0.0001); an increase of ~25 min week-1 . No changes were observed in obesity-related outcomes; waist circumference (P = 0.06), body mass (P = 0.05) and body mass index (P = 0.35). eHealth interventions are effective at increasing min week-1 of moderate-to-vigorous physical activity among working-age women from high income countries.
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Affiliation(s)
- L M Cotie
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - S A Prince
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - C G Elliott
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - M C Ziss
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - L A McDonnell
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - K A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - S Hiremath
- Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Division of Nephrology, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Canada
| | - A L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada
| | - R D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada
| | - J L Reed
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Mendoza-Vasconez AS, Marquez B, Benitez TJ, Marcus BH. Psychometrics of the self-efficacy for physical activity scale among a Latina women sample. BMC Public Health 2018; 18:1097. [PMID: 30185171 PMCID: PMC6125999 DOI: 10.1186/s12889-018-5998-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/28/2018] [Indexed: 01/02/2023] Open
Abstract
Background Even though Latinos have become a priority population for the promotion of physical activity in the United States, several widely used scales in physical activity promotion research have not been validated among this population, particularly in Spanish. This study aims to assess the validity and other psychometrics of the Self-Efficacy for Physical Activity scale among a sample of Spanish-speaking Latina women who participated in the Pasos Hacia La Salud intervention. We also explored alternatives for scale simplification. Methods Data from 205 women corresponding to baseline, 6-month, and 12-month time points were analyzed. Internal consistency was assessed. A series of Spearman correlations, t-tests, linear regressions, and logistic regressions were used to assess the concurrent and predictive validity of the Self Efficacy for Physical Activity scale against both self-report and accelerometer-measured physical activity, using both continuous and categorical outcome data. Item Response Theory and factor analysis methods were used to explore alternatives to simplify the scale. Psychometric tests were repeated with the simplified scale. Results Cronbach’s alpha for the original scale was .72, .76, and .78 for baseline, 6-month, and 12-month data respectively. All concurrent validity tests conducted with 6-month and 12-month data, but not with baseline data, were statistically significant. Self-efficacy at 6 months was also predictive of physical activity at 12 months for all tests except one. Based on plots of Option Characteristic Curves, a modified version of the scale was created. Psychometric results of the modified scale were similar to those of the original scale. Conclusions This study confirmed the scale’s reliability and validity, and revealed that the scale’s accuracy improves when some response items are collapsed, which is an important finding for future research among populations with low literacy levels.
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- Department of Family Medicine & Public Health, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093-0725, USA. .,Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
| | - Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093-0725, USA
| | - Tanya J Benitez
- Department of Family Medicine & Public Health, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093-0725, USA
| | - Bess H Marcus
- Department of Family Medicine & Public Health, University of California San Diego, 9500 Gilman Drive, San Diego, CA, 92093-0725, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA
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Larsen B, Benitez T, Cano M, Dunsiger SS, Marcus BH, Mendoza-Vasconez A, Sallis JF, Zive M. Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study. J Med Internet Res 2018; 20:e170. [PMID: 29743151 PMCID: PMC5966649 DOI: 10.2196/jmir.9206] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/25/2018] [Accepted: 02/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination. OBJECTIVE This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. METHODS A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers. RESULTS Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies. CONCLUSIONS Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Tanya Benitez
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Mayra Cano
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Shira S Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, RI, United States
| | - Bess H Marcus
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Andrea Mendoza-Vasconez
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - James F Sallis
- Department of Family Medicine & Public Health, University of California, San Diego, San Diego, CA, United States
| | - Michelle Zive
- Center for Community Health, Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
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Pekmezi D, Ainsworth C, Joseph RP, Williams V, Desmond R, Meneses K, Marcus B, Demark-Wahnefried W. Pilot Trial of a Home-based Physical Activity Program for African American Women. Med Sci Sports Exerc 2018; 49:2528-2536. [PMID: 28704343 DOI: 10.1249/mss.0000000000001370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aimed to assess the feasibility of a Home-based, Individually-tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. METHODS A pilot randomized trial of the HIPP intervention (N = 43) versus wellness contact control (N = 41) was conducted. Recruitment, retention, and adherence were examined, along with physical activity (7-d physical activity recalls, accelerometers) and related psychosocial variables at baseline and 6 months. RESULTS The sample included 84 overweight/obese African American women 50-69 yr old in Birmingham, AL. Retention was high at 6 months (90%). Most participants reported being satisfied with the HIPP program and finding it helpful (91.67%). There were no significant between-group differences in physical activity (P = 0.22); however, HIPP participants reported larger increases (mean of +73.9 min·wk (SD 90.9)) in moderate-intensity or greater physical activity from baseline to 6 months compared with the control group (+41.5 min·wk (64.4)). The HIPP group also reported significantly greater improvements in physical activity goal setting (P = 0.02) and enjoyment (P = 0.04) from baseline to 6 months compared with the control group. There were no other significant between-group differences (6-min walk test, weight, physical activity planning, behavioral processes, stage of change); however, trends in the data for cognitive processes, self-efficacy, outcome expectations, and family support for physical activity indicated small improvements for HIPP participants (P > 0.05) and declines for control participants. Significant decreases in decisional balance (P = 0.01) and friend support (P = 0.03) from baseline to 6 months were observed in the control arm and not the intervention arm. CONCLUSIONS The HIPP intervention has great potential as a low-cost, high-reach method for reducing physical activity-related health disparities. The lack of improvement in some domains may indicate that additional resources are needed to help this target population reach national guidelines.
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Affiliation(s)
- Dori Pekmezi
- 1School of Public Health, University of Alabama at Birmingham, Birmingham, AL; 2College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; 3Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL; 4School of Nursing, University of Alabama at Birmingham, Birmingham, AL; 5School of Public Health, Brown University, Providence, RI; and 6Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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Garcia DS. A review of healthy weight behavior maintenance in Hispanic women. Health Care Women Int 2018; 40:407-432. [PMID: 29308977 DOI: 10.1080/07399332.2017.1421197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Healthy weight behavior maintenance is key to prevent overweight and obesity in Hispanic/Latino women, particularly for those who are more likely to be sedentary. In this paper, I review the intervention components used by various researchers for successful healthy weight behavior maintenance for Hispanic women. Randomized and experimental studies were located (N = 9) through computer and manual searches in identified articles dated between 1992 and 2015. The methodological characteristics and components of the intervention studies were analyzed systematically. Maintenance of behavior was determined by the statistical significant behavior change and by the effective magnitude of the intervention effect report, favoring the experimental groups in the follow-up periods. Intervention components supporting Hispanic women's weight-related behavior changes and maintenance included interpersonal contact, intervention duration, and the use of cultural motivation and social support strategies. Seven studies were found to be successful in maintaining behavior change, although their retention rates at follow-up completion had either wide-ranging variations or were not specified. The findings are discussed, and recommendations are made so future efforts may successfully employ weight-related intervention strategies for behavior maintenance in Hispanic women.
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Affiliation(s)
- Daisy S Garcia
- a Nursing Faculty, Seattle University , Seattle , Washington , USA
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33
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017. [PMID: 28351367 DOI: 10.1186/s12966–017–0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. METHODS The inclusion criteria specified RCTs with ≥ 12 weeks' duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. RESULTS We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. CONCLUSION There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. TRIAL REGISTRATION PROSPERO CRD42015020624.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act 2017; 14:42. [PMID: 28351367 PMCID: PMC5370453 DOI: 10.1186/s12966-017-0494-y] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/13/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics. Methods The inclusion criteria specified RCTs with ≥ 12 weeks’ duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I2) and regression coefficients. Results We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I2 = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I2 = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term. Conclusion There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time. Trial Registration PROSPERO CRD42015020624 Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0494-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gro Beate Samdal
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Geir Egil Eide
- Department for Research and Development, Haukeland University Hospital, Bergen, Norway.,Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tom Barth
- Member of Motivational Interviewing Network of Trainers (MINT), Allasso, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Murray KE, Ermias A, Lung A, Mohamed AS, Ellis BH, Linke S, Kerr J, Bowen DJ, Marcus BH. Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity. Transl Behav Med 2017; 7:6-15. [PMID: 27558245 PMCID: PMC5352647 DOI: 10.1007/s13142-016-0436-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
There is pressing need for innovation in clinical research to more effectively recruit, engage, retain, and promote health among diverse populations overburdened by health disparities. The purpose of this study is to provide a detailed illustration of the cultural adaptation of an evidence-based intervention to bolster translational research with currently underserved communities. The cultural adaptation heuristic framework described by Barrera and colleagues is applied to the adaptation of a physical activity evidence-based intervention with adult Somali women. Widespread changes were required to ensure program feasibility and acceptability, including the reduction of assessment protocols and changes discordant with current trends in physical activity research. The cultural adaptation of evidence-based interventions offers an important mechanism for reducing health disparities. Improved reporting standards, assessment of features relevant to underserved communities, and greater funding requirements to ensure better representation are needed to promote more widespread access for all people.
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Affiliation(s)
- Kate E Murray
- Department of Family Medicine & Public Health, UC San Diego, San Diego, CA, USA.
- School of Psychology and Counselling, Queensland University of Technology, QUT-Kelvin Grove Campus, GPO, Box 2434, Brisbane, Queensland, 4001, Australia.
| | - Azieb Ermias
- The Health Management Academy, Alexandria, VA, USA
| | - Amber Lung
- Clinton Health Access Initiative, Boston, MA, USA
| | | | - B Heidi Ellis
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Linke
- Department of Family Medicine & Public Health, UC San Diego, San Diego, CA, USA
| | - Jacqueline Kerr
- Department of Family Medicine & Public Health, UC San Diego, San Diego, CA, USA
| | - Deborah J Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Bess H Marcus
- Department of Family Medicine & Public Health, UC San Diego, San Diego, CA, USA
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36
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Physical activity maintenance among Spanish-speaking Latinas in a randomized controlled trial of an Internet-based intervention. J Behav Med 2016; 40:392-402. [PMID: 27752866 DOI: 10.1007/s10865-016-9800-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
Spanish-speaking Latinas have some of the lowest rates of meeting physical activity guidelines in the U.S. and are at high risk for many related chronic diseases. The purpose of the current study was to examine the maintenance of a culturally and individually-tailored Internet-based physical activity intervention for Spanish-speaking Latinas. Inactive Latinas (N = 205) were randomly assigned to a 6-month Tailored Physical Activity Internet Intervention or a Wellness Contact Control Internet Group, with a 6-month follow-up. Maintenance was measured by assessing group differences in minutes per week of self-reported and accelerometer measured moderate to vigorous physical activity (MVPA) at 12 months after baseline and changes in MVPA between the end of the active intervention (month 6) and the end of the study (month 12). Potential moderators of the intervention were also examined. Data were collected between 2011 and 2014, and were analyzed in 2015 at the University of California, San Diego. The Intervention Group engaged in significantly more minutes of MVPA per week than the Control Group at the end of the maintenance period for both self-reported (mean diff. = 30.68, SE = 11.27, p = .007) and accelerometer measured (mean diff. = 11.47, SE = 3.19, p = .01) MVPA. There were no significant between- or within-group changes in MVPA from month 6 to 12. Greater intervention effects were seen for those with lower BMI (BMI × intervention = -6.67, SE = 2.88, p = .02) and lower perceived places to walk to in their neighborhood (access × intervention = -43.25, SE = 19.07, p = .02), with a trend for less family support (social support × intervention = -3.49, SE = 2.05, p = .08). Acculturation, health literacy, and physical activity related psychosocial variables were not significant moderators of the intervention effect during the maintenance period. Findings from the current study support the efficacy of an Internet-delivered individually tailored intervention for maintenance of MVPA gains over time.
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37
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Marquez B, Dunsiger SI, Pekmezi D, Larsen BA, Marcus BH. Social support and physical activity change in Latinas: Results from the Seamos Saludables trial. Health Psychol 2016; 35:1392-1401. [PMID: 27669178 DOI: 10.1037/hea0000421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Family responsibilities and poor social support are barriers to physical activity among Latinas. This study evaluated the effects of a home- and print-based intervention on social support, moderating effects of familial ties on support and moderate-to-vigorous physical activity (MVPA), and mediating effects of support on MVPA. METHOD Participants were randomized to receive through the mail either individually tailored physical activity intervention or general wellness print materials. Familial ties and social support were assessed by marital and child status and the social support for physical activity measure, respectively. MVPA was measured using the 7-day Physical Activity Recall Interview and accelerometer. Assessments were conducted at baseline, 6 months posttreatment, and 12 months follow-up. RESULTS Participants (n = 266; 40.6 ± 9.9 years old) were mostly immigrant and Spanish-speaking Latinas. The intervention group achieved greater increases in family and friend support compared to the wellness control group from baseline to posttreatment and follow-up (p < .05). Intervention changes in support did not depend on marital or child status. The intervention also increased minutes per week of MVPA more than the wellness control (p < .05) and the effect did not depend on marital or child status. There were significant indirect effects of treatment, indicating the intervention achieved greater increases in MVPA by increasing family (ab = 5.21, SE = 2.94, 95% confidence interval [CI] = 0.91-14.11) and friend (ab = 6.83, SE = 5.15, 95% CI = 0.16-20.56) support. CONCLUSIONS The intervention improved and sustained support from family and friends and MVPA irrespective of familial ties. Social support mediated increases in MVPA. (PsycINFO Database Record
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Affiliation(s)
| | - Shira I Dunsiger
- of Psychiatry & Human Behavior, Miriam Hospital, Brown University
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama
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Abstract
Public policies, population health initiatives, and targeted behavioral change interventions for individuals at risk for developing diabetes are all essential for diabetes prevention in Latin American countries (LACs). This scoping review examines (1) the current evidence on diabetes prevention policies and interventions in LACs to identify components of effective diabetes prevention models in those countries and (2) effective diabetes prevention interventions targeting Latino populations in the USA to explore possible lessons from these interventions for LACs. Diabetes prevention programs in LACs evaluated to date consist of short-term health professional-led face-to-face behavioral counseling sessions. Intervention components of US-based programs for Latinos that might benefit diabetes prevention programs in Latin America include (1) deployment of community health workers ("promotoras") for diabetes screening and delivery of lifestyle modification programs, (2) multiple modes of program delivery beyond face-to-face sessions, (3) information technology to automate and enhance program delivery, (4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications, and (5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA.
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Michigan Center for Diabetes Translational Research (MCDTR), University of Michigan, Ann Arbor, MI, USA.
| | - Elizabeth Kaselitz
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
- Global REACH and Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gurpreet K Rana
- Taubman Health Sciences Library, University of Michigan, 1135 East Catherine Street, Ann Arbor, MI, 48109, USA
| | - John D Piette
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research (CCMR), Ann Arbor Veterans' Affairs (VA) Healthcare System, 2215 Fuller Rd. (152), Ann Arbor, MI, 48105, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Callahan LF, Rivadeneira A, Altpeter M, Vilen L, Cleveland RJ, Sepulveda VE, Hackney B, Reuland DS, Rojas C. Evaluation of the Arthritis Foundation's Camine Con Gusto Program for Hispanic Adults With Arthritis. HISPANIC HEALTH CARE INTERNATIONAL 2016; 14:132-40. [PMID: 27553228 DOI: 10.1177/1540415316665202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Camine Con Gusto (CCG) is the Hispanic version of an evidence-based walking program for people with arthritis. This study examined CCG outcomes, feasibility, tolerability, safety, and acceptability and potential tailoring. METHOD A pre and post 6-week evaluation was conducted in Hispanic people with arthritis. Outcomes included pain, stiffness, fatigue, functional capacity, helplessness, and self-efficacy. A formative evaluation with program participants and key stakeholders explored program tailoring. RESULTS Participants' mean age was 46.9 years, 44.4% had a high school degree or less, 2.5% were born in United States, 60.1% spoke only Spanish, and 74.7% were female. Moderate effect sizes were found: 0.50 for pain, 0.75 for fatigue, 0.49 for stiffness, 0.33 for function, 0.26 for helplessness, and 0.24 for self-efficacy. There were 285 participants recruited with an 82% 6-week retention (feasibility), no adverse events were reported (safety), and 98% reported program satisfaction (acceptability). Recommended adaptations included simpler language, more pictures and content addressing nutrition and chronic conditions, shortened materials, and inclusion of motivational strategies. CONCLUSION CCG showed improvement in outcomes in Hispanic individuals comparable to those noted in non-Hispanic White and Black individuals with arthritis.
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Affiliation(s)
| | | | - Mary Altpeter
- University of North Carolina at Chapel Hill, NC, USA
| | - Leigha Vilen
- University of North Carolina at Chapel Hill, NC, USA
| | | | | | - Betsy Hackney
- University of North Carolina at Chapel Hill, NC, USA
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40
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Pasos Saludables: A Pilot Randomized Intervention Study to Reduce Obesity in an Immigrant Farmworker Population. J Occup Environ Med 2016; 57:1039-46. [PMID: 26461858 DOI: 10.1097/jom.0000000000000535] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate a workplace-based diet and physical activity intervention to reduce obesity in a Latino farmworker population. METHODS 254 Latino farmworkers were allocated in a 1:2 control:intervention ratio to parallel groups in this randomized controlled study, [Clinical Trial ID# NCT01855282]. Intervention participants attended 10 weekly educational sessions led by promotoras. All participants had anthropometry and lifestyle habits recorded before randomization and at follow-up after 12-14 weeks. RESULTS Seventy percent (n = 112 intervention and 66 control) completed the study. Intervention females (not controls) decreased the primary outcome measures of weight, BMI, and waist circumference (mean [95% CI]) of -0.7 [-1.3 to -0.1] kg, -0.3 [-0.4 to -0.2] and -0.9 [-1.7 to -0.1] cm, respectively. Intervention participants increased water consumption, fruit and vegetable servings, and moderate physical activity in a dose-dependent fashion. CONCLUSIONS The successful pilot workplace intervention offers a model to reach otherwise difficult-to-access Latino farmworkers.
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Eaton CB, Hartman SJ, Perzanowski E, Pan G, Roberts MB, Risica PM, Gans KM, Jakicic JM, Marcus BH. A Randomized Clinical Trial of a Tailored Lifestyle Intervention for Obese, Sedentary, Primary Care Patients. Ann Fam Med 2016; 14:311-9. [PMID: 27401418 PMCID: PMC4940460 DOI: 10.1370/afm.1952] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/22/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity. METHODS We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2. RESULTS Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity. CONCLUSION A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.
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Affiliation(s)
- Charles B Eaton
- Alpert Medical School of Brown University, Providence, Rhode Island Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California Cancer Prevention and Control, UC San Diego Moores Cancer Center, La Jolla, California
| | - Elizabeth Perzanowski
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Guohui Pan
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Mary B Roberts
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Patricia M Risica
- Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island Institute for Community Health Promotion, School of Public Health, Brown University, Providence, Rhode Island
| | - Kim M Gans
- Institute for Community Health Promotion, School of Public Health, Brown University, Providence, Rhode Island Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut Center for Health Interventions and Prevention, University of Connecticut, Storrs, Connecticut
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Marcus BH, Hartman SJ, Larsen BA, Pekmezi D, Dunsiger SI, Linke S, Marquez B, Gans KM, Bock BC, Mendoza-Vasconez AS, Noble ML, Rojas C. Pasos Hacia La Salud: a randomized controlled trial of an internet-delivered physical activity intervention for Latinas. Int J Behav Nutr Phys Act 2016; 13:62. [PMID: 27234302 PMCID: PMC4884436 DOI: 10.1186/s12966-016-0385-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/14/2016] [Indexed: 11/29/2022] Open
Abstract
Background Internet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention. Methods Inactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego. Results Increases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p < 0.01). Increases in objectively measured MVPA were also significantly larger in the Intervention Group (mean differences = 31.0, SE = 10.7, p < .01). The Intervention Group was also significantly more likely to meet national physical activity guidelines at 6 months (OR = 3.12, 95 % CI 1.46–6.66, p < .05). Conclusion Findings from the current study suggest that this Internet-delivered individually tailored intervention successfully increased MVPA in Latinas compared to a Wellness Contact Control Internet Group. Trial registration NCT01834287.
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Affiliation(s)
- Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA.
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, RI and Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Sarah Linke
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Becky Marquez
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Kim M Gans
- Department of Behavioral and Social Sciences and the Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, RI and Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Madison L Noble
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Carlos Rojas
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
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Using Web-Based Technology to Promote Physical Activity in Latinas: Results of the Muévete Alabama Pilot Study. Comput Inform Nurs 2016; 33:315-24. [PMID: 26049367 DOI: 10.1097/cin.0000000000000162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Latinas in the US report high levels of physical inactivity and are disproportionally burdened by related health conditions (eg, type 2 diabetes, obesity), highlighting the need for innovative strategies to reduce these disparities. A 1-month single-arm pretest-posttest design was utilized to assess the feasibility and acceptability of a culturally and linguistically adapted Internet-based physical activity intervention for Spanish-speaking Latinas. The intervention was based on the Social Cognitive Theory and the Transtheoretical Model. Changes in physical activity and related psychosocial variables were measured at baseline and the end of the 1-month intervention. The sample included 24 Latina adults (mean age, 35.17±11.22 years). Most (83.3%) were born outside the continental US. Intent-to-treat analyses showed a significant increase (P=.001) in self-reported moderate- to vigorous-intensity physical activity from a median of 12.5 min/wk at baseline to 67.5 min/wk at the 1-month assessment. Participants reported significant increases in self-efficacy as well as cognitive and behavioral processes of change. Nearly half of the participants (45.8%) reported advancing at least one stage of change during the course of the 1-month intervention. Findings support the feasibility and acceptability of using interactive Internet-based technology to promote physical activity among Latinas in Alabama.
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Linke SE, Larsen BA, Marquez B, Mendoza-Vasconez A, Marcus BH. Adapting Technological Interventions to Meet the Needs of Priority Populations. Prog Cardiovasc Dis 2016; 58:630-8. [PMID: 26957186 DOI: 10.1016/j.pcad.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 02/02/2023]
Abstract
Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations.
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Affiliation(s)
- Sarah E Linke
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA.
| | - Britta A Larsen
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Andrea Mendoza-Vasconez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Bess H Marcus
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
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Long-term Surveillance of Physical Activity Habits of Latinas Enrolled in a 12-Month Physical Activity Intervention. J Phys Act Health 2016; 13:740-6. [PMID: 26901839 DOI: 10.1123/jpah.2015-0482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Long-term physical activity surveillance has not been conducted among Latinas. This study explored the variability of daily physical activity habits of inactive adult Latinas participating in a 12-month physical activity intervention. METHODS We collected objective physical activity data (pedometer) from 139 Spanish speaking Latinas (age = 41.6 ± 10.1 years; BMI = 29.6 ± 4.3 kg/m2) enrolled in a 12-month physical activity intervention. Total and aerobic steps (>100 steps/minute) were computed by year, season, month, day of week, time of day, and hour. RESULTS Participants walked an average of 6509 steps/day of which 1303 (20%) were aerobic steps. Significant physical activity differences were observed for subgroups including generational status, education, employment, income, marital status and health literacy. Significant and similar differences were observed for both total steps and aerobic steps for day of the week (weekdays > weekends) and season (summer > spring > fall > winter). Opposing trends were observed over the course of the day for total steps (early afternoon > late morning > late afternoon > early morning > evening) and aerobic steps (early morning > evening > late morning > late afternoon > early afternoon). CONCLUSIONS Both seasonality and week day predicted physical activity habits of Latinas. This is the first long-term study to track daily physical activity habits of Latinas. These data have potential to inform the design of future physical activity interventions targeting Latinas.
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Larsen B, Gilmer T, Pekmezi D, Napolitano MA, Marcus BH. Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control. Int J Behav Nutr Phys Act 2015; 12:140. [PMID: 26559336 PMCID: PMC4642691 DOI: 10.1186/s12966-015-0302-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 10/30/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas. METHODS Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs. RESULTS At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months. CONCLUSIONS While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population. TRIAL REGISTRATION NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, USA.
| | - Melissa A Napolitano
- Departments of Prevention and Community Health & Exercise and Nutrition Sciences, The George Washington University School of Public Health, ., ..
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
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Correa-de-Araujo R. Evidence-Based Practice in the United States: Challenges, Progress, and Future Directions. Health Care Women Int 2015; 37:2-22. [PMID: 26473771 PMCID: PMC4804828 DOI: 10.1080/07399332.2015.1102269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Scientific literature demonstrates that advances in evidence-based nursing have improved systems of care and women's health outcomes. Experts agree that nurses worldwide can play a key role in building such evidence and working with interdisciplinary health care teams and systems to accelerate its implementation.
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Marcus BH, Hartman SJ, Pekmezi D, Dunsiger SI, Linke SE, Marquez B, Gans KM, Bock BC, Larsen BA, Rojas C. Using interactive Internet technology to promote physical activity in Latinas: Rationale, design, and baseline findings of Pasos Hacia La Salud. Contemp Clin Trials 2015; 44:149-158. [PMID: 26255237 DOI: 10.1016/j.cct.2015.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022]
Abstract
Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6months with a tapered dose during the second 6months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.
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Affiliation(s)
- Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, AL, United States.
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States; The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, United States.
| | - Sarah E Linke
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Becky Marquez
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Kim M Gans
- Department of Human Development and Family Studies, Center for Health Interventions and Prevention, University of Connecticut, United States; Institute for Community Health Promotion, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States.
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States; The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, United States.
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Carlos Rojas
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
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Clinical decision support system in medical knowledge literature review. INFORMATION TECHNOLOGY & MANAGEMENT 2015. [DOI: 10.1007/s10799-015-0216-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Marcus BH, Dunsiger SI, Pekmezi D, Larsen BA, Marquez B, Bock BC, Gans KM, Morrow KM, Tilkemeier P. Twelve-month physical activity outcomes in Latinas in the Seamos Saludables trial. Am J Prev Med 2015; 48:179-182. [PMID: 25442225 PMCID: PMC5718346 DOI: 10.1016/j.amepre.2014.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/03/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity interventions designed for Latinas have shown short-term behavior change, but longer-term change and maintenance is rarely measured. PURPOSE To assess physical activity change at 12 months, following 6-month tapered completion of an RCT of a physical activity intervention for Latinas. METHODS Two hundred sixty-six underactive (<60 minutes/week physical activity) Latinas were randomized to an individually tailored, culturally and linguistically adapted physical activity intervention, or a wellness contact control. Participants received the materials through the mail for 6 months, then received booster doses at 8, 10, and 12 months. Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months. Data were collected at Brown University between 2009 and 2013, and analyses were conducted in 2013. RESULTS At 12 months, increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group (mean difference=52 minutes/week, SE=9.38, p<0.01), with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months. Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines (OR=3.14, p=0.01). CONCLUSIONS The intervention was more effective than the wellness control at 12 months, and physical activity increases from baseline to 6 months were maintained, suggesting the intervention may lead to sustainable behavior change. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT01583140.
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Affiliation(s)
- Bess H Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, California.
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Britta A Larsen
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Becky Marquez
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kim M Gans
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kathleen M Morrow
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter Tilkemeier
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
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