Short-Term Effects of a LifestyleShort-Term Effects of a LifestyleBehavior Intervention for Overweight Behavior Intervention for Overweight
Latino WomenLatino Women
Deborah Koniak-Griffin, RNC, EdD, FAANDeborah Koniak-Griffin, RNC, EdD, FAANProfessor & Audrienne H. Moseley Endowed Chair Professor & Audrienne H. Moseley Endowed Chair
in Women’s Health Researchin Women’s Health Research
2012 State of the Science 2012 State of the Science Congress on Nursing ResearchCongress on Nursing ResearchSept 15, 2012Sept 15, 2012
NHLBI, R01HL086931-1A1NHLBI, R01HL086931-1A1Co-Investigators: Co-Investigators: Aurelia O’Connell,Aurelia O’Connell,Antronette Yancey, Mary-Lynn Brecht,Antronette Yancey, Mary-Lynn Brecht,Gail HarrisonGail Harrison
Background: Several factors influenced decision to test a lifestyle behavior intervention for overweight Latino women.
Latinos: fastest growing minority population in U.S.
Modifiable lifestyle behaviors influence risk for CVD, diabetes and other chronic diseases that disproportionately impact Latinos overweight/obesity; sedentary lifestyle dietary intake, e.g., increased fat with acculturation
Often lack access to prevention information Earlier partnered projects involving CVPR and
community supported need for study Proposal developed with promotoras & community
AimAim: To evaluate the short-term effects of a : To evaluate the short-term effects of a healthy lifestyle behavior intervention (LSBI) on healthy lifestyle behavior intervention (LSBI) on selected behavioral and clinical outcomes of selected behavioral and clinical outcomes of overweight Latino women.overweight Latino women.
Randomization
Health Program II (n=112)Preparedness/Home Safety
8 group classes spread over 2 months + ITC for 4 months (6 months)
Recruitment and Screening (overweight, 35-64 yrs, Latina)
First Evaluation (n=223)BMI, waist size, BP, physical activity, lipid panel + FBS, questionnaires
Program I: LSBI (n=111)Su Corazon, Su Vida (Your Heart, Your
Life) taught by promotoras8 group classes spread over 2 months + ITC for 4 months (6 months)
Second Evaluation (n=98)(at program completion, 6 months later)
Same procedures as baseline evaluation(88.3% retention)
Third Evaluation (n=99)(about 9 months after first evaluation)
(89.2% retention)
Second Evaluation (n=95)(at program completion, 6 months later)
Same procedures as baseline evaluation(84.8% retention)
Third Evaluation (n=94)(about 9 months after first evaluation)
(83.9% retention)
CBPRAPPROACH
RecruitmentRecruitment
313 Interested and Screened
972 Uninterested
249 Eligible
64 Ineligible
223 Enrolled, Randomized& Started Program
112 Control111 LSBI
Eligibility Criteria Latina 35-64 years BMI > 25 Fluent in Spanish or English
Excluded Insulin dependent diabetes Uncontrolled HTN History of a heart attack or stroke
1285 Approached
8 Group Education sessions (Su Corazon, Su Vida) - 1½ to 2 hours led by promotoras adapted to promote weight loss
8 Individual Teaching and Coaching sessions Incorporates culture (food culture, symbols) Participatory – role play, scenarios, demonstrations Heart healthy behaviors – physical activity and
nutrition
Lifestyle Behavior Intervention Lifestyle Behavior Intervention (LSBI)
Theory-based, culturally-tailored, participatory
Control Control ConditionCondition Comparable Comparable lengthlength
DATA COLLECTION: Community-Based
Cholestech evaluateslipids in 5 min with
fingerstick
Sample Characteristics Sample Characteristics (n=223)(n=223)SociodemographicSociodemographic Latina immigrants, Mexican descent: 84%Latina immigrants, Mexican descent: 84% Low acculturation: Mean = 1.48, SD = .45; 1(low) - Low acculturation: Mean = 1.48, SD = .45; 1(low) -
5(high)5(high) 35-64 years old (Mean = 44.6 yrs, SD = 7.9)35-64 years old (Mean = 44.6 yrs, SD = 7.9) Married/living together: 72.2%Married/living together: 72.2% << 8 8thth grade education: 52.6% grade education: 52.6% Low income; no health insurance: 68.2%Low income; no health insurance: 68.2% Diabetes (FBS Diabetes (FBS >> 126 mg/dL 126 mg/dL oror on oral meds): 6.3% on oral meds): 6.3% Hypertension (BP Hypertension (BP >> 140/90 mmHg 140/90 mmHg oror on on
antihypertensive meds): 12.1%antihypertensive meds): 12.1%
Sample Characteristics Sample Characteristics (n=223)(n=223)Clinical VariablesClinical Variables BMI: Mean = 32.6, SD = 5.7 BMI: Mean = 32.6, SD = 5.7 Waist circumference: Mean = 101.4 cm Waist circumference: Mean = 101.4 cm
(39.9(39.9 in), SD = 11.5cm (4.5 in)in), SD = 11.5cm (4.5 in) BP: Mean = 114/75BP: Mean = 114/75 CholesterolCholesterol
Total-C: Mean = 188.4, SD = 33.8Total-C: Mean = 188.4, SD = 33.8 HDL-C: Mean = 44.5, SD = 13.4HDL-C: Mean = 44.5, SD = 13.4 LDL-C: Mean = 111.6, SD = 29.2LDL-C: Mean = 111.6, SD = 29.2 Triglycerides: Mean = 165, SD = 87.9Triglycerides: Mean = 165, SD = 87.9
FBS: Mean = 100.43, SD = 18.8FBS: Mean = 100.43, SD = 18.8
FindingsFindings Mixed effects model to test for change over
time between groups (age adjusted); significant differences at 6 and 9 months for:
Lifestyle behaviors, F = 5.02, p=.008• LSBI group improved dietary habits
Waist circumference, F = 3.26, p=.04• decreased 2.84 cm (1.12 in) in LSBI group
Significant effects from baseline to 9 months for daily steps, t = 2.07, p =.048
Pretest-Posttest comparison showed significant improvement in scores for Heart Knowledge questionnaire
Accelerometer Readings of Daily StepsAccelerometer Readings of Daily Steps
GroupGroup Baseline, Mean Baseline, Mean (SD)(SD)
6 Months, Mean 6 Months, Mean (SD)(SD)
9 Months, Mean 9 Months, Mean (SD)(SD)
LSBILSBI 8600.92 8600.92 (3149.57)(3149.57)
8768.89 (2747.42) 8768.89 (2747.42)
8641.46 (2833.44)8641.46 (2833.44)
ContrControlol
8522.00 8522.00 ((3259.81))
8480.16 (3506.18)8480.16 (3506.18) 7312.48 (2700.82)7312.48 (2700.82)
8600.92
8768.898641.46
8522.008480.16
7312.487200
7700
8200
8700
Baseline 6 Months 9 Months
LSBIControl
Feasibility FindingsFeasibility Findings Promotoras/CHW able to recruit hard-to-
reach population and deliver LSBI Well accepted in community Extensive training & close supervision needed Challenges, e.g., written record keeping, time
management, organizational skills Attendance at LSBI classes
Attended at least half of classes: n=92 women (82.9%)
Attended entire series of classes: n=44 women (39.6%)
Conclusions and Conclusions and RecommendationsRecommendations
Findings support positive short-term effects of LSBI on: lifestyle behaviors (dietary) waist circumference physical activity
Further strategies or more focused approach may be needed to promote weight loss
Promotora model of LSBI delivery has many strengths
and works well with immigrant Latinas Recommendations
RCT with long-term follow-up Strategies to further develop promotoras as community
resource