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Entertainment education and the promotora model are 2 evidence-based health communication strategies. This study examined their combined effect on promoting healthy eating among mothers in a family-based intervention. Participants were 361 Mexican-origin families living in Imperial County, California, who were randomly assigned to an intervention o...
Context in source publication
Context 1
... example, the characters depicted attitudes and behaviors that impacted their eating habits, including the effects of machismo and concerns regarding food security. In addition, consistent with family systems theory (Broderick, 1993), the episodes showed how family members influenced each other's dietary behaviors in different con- texts, including at home, in grocery stores, in restaurants, and in the community (see Figure 1 for DVD images). In many cases, these sources of influence were depicted as nega- tive, for example, showing how the behavior of one person was sabotaging the efforts of others in the grocery store. ...
Citations
... A video edutainment intervention in homes among Mexican-origin families in the USA improved dietary choices among mothers and improved dietary intake. 7 In Thailand, a before-after study of an edutainment module on mobile tablets reported improved knowledge and perceptions about childhood immunisation among mothers in hard-to-reach, under-vaccinated populations. 8 These studies measured the impact of edutainment videos as part of an overall home visits package; they do not provide information about the specific contribution of the edutainment videos to the impact on the targeted outcomes. ...
... A controlled trial of a home visits intervention among Mexican-origin families in the USA reported improved outcomes of maternal diet and behaviours. 7 The intervention used a combination of videos, discussions and workbooks to engage families; experienced health workers visited each family 11 times and placed 4 phone calls to them. The delayed-intervention control group did not receive any home visits. ...
Objective
A trial of evidence-based health promotion home visits to pregnant women and their spouses in northern Nigeria found significant improvements in maternal and child health outcomes. This study tested the added value for these outcomes of including video edutainment in the visits.
Methods
In total, 19,718 households in three randomly allocated intervention wards (administrative areas) received home visits including short videos on android handsets to spark discussion about local risk factors for maternal and child health; 16,751 households in three control wards received visits with only verbal discussion about risk factors. We compared outcomes between wards with and without videos in the visits, calculating the odds ratio (OR) and 95% confidence interval (95%CI) of differences, in bivariate and then multivariate analysis adjusting for socio-economic differences between the video and non-video wards.
Results
Pregnant women from video wards were more likely than those from non-video wards to have discussed pregnancy and childbirth often with their husbands (OR 2.22, 95%CI 1.07–4.59). Male spouses in video wards were more likely to know to give more fluids and continued feeding to a child with diarrhoea (OR 1.61, 95%CI 1.21–2.13). For most outcomes there was no significant difference between video and non-video wards. The home visitors who shared videos considered they helped pregnant women and their spouses to appreciate the information about risk factors.
Conclusion
The lack of added value of the videos in the context of a research study may reflect the intensive training of home visitors and the effective evidence-based discussions included in all the visits. Further research could rollout routine home visits with and without videos and test the impact of video edutainment added to home visits carried out in a routine service context.
... 17,[19][20][21]23,[25][26][27][28]34,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Many classes were participatory and included demonstrations and taste tests. [19][20][21]26,33,34,[40][41][42]45,48,50,52 One-on-one mentoring between the CHW and participants was included in 7 studies 18,[42][43][44][45]54,55 and 6 studies used this approach exclusively. 16,22,24,[56][57][58] Multiple studies supplemented group sessions with individualized phone calls or home visits by the CHW to the participant. ...
... 16,22,24,[56][57][58] Multiple studies supplemented group sessions with individualized phone calls or home visits by the CHW to the participant. 17,40,[42][43][44][45]54 Studies also used newsletters, print materials, or videos to deliver intervention messages. 20,[31][32][33]40,42,50,51,54,55,57 Description of the CHWs Several studies recruited individuals to serve as CHWs because of their status as natural helpers, mentors, leaders, or respected neighbors. ...
... 17,40,[42][43][44][45]54 Studies also used newsletters, print materials, or videos to deliver intervention messages. 20,[31][32][33]40,42,50,51,54,55,57 Description of the CHWs Several studies recruited individuals to serve as CHWs because of their status as natural helpers, mentors, leaders, or respected neighbors. 17,20,26,27,29,39,40,55 Others recruited CHWs for the intervention from existing networks of CHWs, promotoras, or Cooperative Extension Master volunteers. ...
Objective
To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.)
Data Source
Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020.
Study Inclusion and Exclusion Criteria
English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries.
Data Extraction
Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes.
Data Synthesis
Data were analyzed by the lead investigator and described narratively.
Results
Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations.
Conclusions
The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.
... DsR was developed based on a culturally grounded approach (Colby et al., 2013;Hecht & Krieger, 2006) to teach adolescents communication resistance, risk assessment, and decision-making, which have been shown to reduce adolescent risky behaviors as well as to foster positive interpersonal relationships (Hecht, Graham, & Elek, 2006;Hecht, Shin, Pettigrew, Miller-Day, & Krieger, 2018;Wolfe et al., 2009). The DsR intervention promotes narrative persuasion via a form of entertainment-education (E-E), which has been utilized as an effective means for public health interventions (Ayala et al., 2015;Roberto, Murray-Johnson, & Witte, 2011;Singhal & Rogers, 1999) and particularly for adolescent substance use prevention research (Guttman, Gesser-Edelsburg, & Israelashvili, 2008;Mitschke, Loebl, Tatafu, Segal Matsunaga, & Cassel, 2010;Nahm et al., 2010). ...
... Empirical evidence shows E-E interventions are especially useful to reach out to the under-served minority population with low health literacy (Jibaja-Weiss & Volk, 2007;Kline et al., 2016). In the context of diabetes interventions, for example, Mexican-heritage mothers who received a family-based, E-E intervention promoting healthy eating behaviors were more likely to serve vegetables to families on a daily basis while less likely to practice unhealthy eating behaviors (Ayala et al., 2015). Hispanic adults who were introduced to fotonovelas, which is a small comic booklet containing educational messages with pictures and captions, showed significant increases in diabetes knowledge as well as stronger intention to exercise and eat fruits and vegetables (Unger et al., 2009). ...
Guided by narrative engagement theory and social cognitive theory, the present study investigates effects of narrative persuasion and peer communication on Nicaraguan adolescent substance use. Eighth-grade students in Nicaragua were recruited to participate in the culturally grounded, school-based prevention intervention Dale se REAL and to watch five entertainment-education intervention videos that teach drug refusal communication strategies. Using the cross-sectional survey (N = 224), a path analysis was run to examine the mediated moderation effects of narrative engagement (e.g., interest, realism, and identification with main characters) and peer communication about the intervention videos (e.g., frequency and valence of communication) on adolescent refusal self-efficacy and substance use behaviors. Results revealed that realism was significantly related to adolescent refusal self-efficacy and frequent peer communication moderated the association between refusal self-efficacy and the past 30-day marijuana use. Findings suggest that health communication scholars should take into consideration social factors and cultural contexts for adolescent substance use prevention research.
... Dietary behavioral strategies were assessed with three subscales using a modified version of an instrument that assessed behaviors associated with improvements in dietary intake [48][49][50][51]. Subscale scores for customers who missed more than 20% of the items in a subscale were not computed. ...
Background
Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months.
Trial design
Clustered randomized controlled trial
Methods
Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors.
Results
The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects.
Conclusions
Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products).
Trial registration
NCT01475526
... While the program targeted nutrition and physical activity behaviors, the program primarily focused on nutrition. The literature guided the team's approach to father engagement [7,12,[31][32][33][34], design and implementation of family-centered programs (health promotion and disease prevention/treatment) [9,11,12], including programs with Latino families, specifically those led by Ayala and colleagues [35][36][37], and our prior research with the community [26,29,30], including formative work related to this grant (see section called Context). The approach also integrated a promotora model, as a team of promotoras (community health workers) collaborated on program design, implementation, and evaluation [35,36]. ...
... Prior programs, such as Ayala et al. Entre Familia: Reflejos de Salud, that used a "whole family approach" also focused on targeting family functioning and parenting behaviors related to food [35,37]. Specifically, the HEPP program aimed to change dietary intake of fruits and vegetables and physical activity at the individual and family level within Mexican-heritage families. ...
... First, there are many unknowns for how best to engage and support Latino fathers in behavioral programs in nutrition [22,34]. However, the literature provides evidence regarding the potential benefits of a family-centered, or as described by Ayala and colleagues, a "whole family" approach that engages the family as a system [35,37]. ...
Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.
... Partnering with community organizations and trained health workers can have many benefits for intervention research (e.g., makes research more relevant to the community [Moore et al., 2016], as well as increases the affordability of the interventions themselves). While there is existing research on community-academic partnerships employing the promotor/a model to deliver communitybased interventions (e.g., Rhodes et al., 2007), most have been conducted within the medical field (e.g., Ayala et al., 2015;Johnson et al., 2013). To our knowledge, no studies have examined the process of collaboration in community-academic research partnerships that seek to develop an attachment-based family intervention in which trained community workers (e.g., promotores) are the central agent of change. ...
Barriers facing effective science-to-practice translation have led scholars to conduct early-stage intervention research within community organizations. We describe our experiences developing a manualized parent-youth attachment-based group therapy intervention within a community health organization dedicated to serving low-income Latinx immigrant families, Latino Health Access (LHA), in which services are rendered by trained community workers (promotores). By conducting a qualitative analysis of interviews with all members of this academic-community partnership (research [Principal Investigator, student researchers] and community agency team members [Administrators, promotores]), we discuss the challenges and opportunities that this collaboration has generated. The results led both the research and community teams to question assumptions about the basic skills, values, and attitudes that underlie the integration of science and practice. We will share the insights that have helped to promote connection and understanding among the stakeholders and the efforts made to support the progress and successes of developing community interventions.
... Community health worker programs can be a critical tool for intervening early and providing much-needed social support and education in promoting breastfeeding. Such programs have been shown to successfully improve health behaviors (Ayala et al., 2015;Shah, Kieffer, Choi, Schumann, & Heisler, 2015). ...
Background
Although breastfeeding is a major public health priority and provides numerous benefits, women veterans encounter many barriers to initiating and sustaining breastfeeding. Women veterans are a growing population with unique health care needs related to exposures and injuries experienced during military service. These military experiences are linked to health diagnoses known to impact postpartum health behaviors, such as breastfeeding.
Research aim
The aim of this study was to identify factors associated with breastfeeding at 4 weeks postpartum among women veterans.
Methods
We used 2016-to-2018 survey data from women veterans ( N = 420), interviewed before and after delivery, who were enrolled in maternity care coordination at a national sample of Veterans Health Administration facilities. Using the social ecological model, logistic regression was employed to explore the relationship between breastfeeding at least 4 weeks and postpartum and maternal/infant characteristics, interpersonal dynamics, community influences, and system factors.
Results
The rate of breastfeeding at 4 weeks postpartum was 78.6% among this sample of veterans. Self-employed participants were 2.8 times more likely to breastfeed than those who were employed outside the home. Participants who had been deployed at any point in their military career were twice as likely to breastfeed compared with those who never deployed. In this study sample, race independently predicted lower rates of breastfeeding, with African American participants being 48% less likely to breastfeed as compared with white participants.
Conclusion
Our analysis suggests significant racial disparities in breastfeeding within veteran populations utilizing Veterans Health Administration, despite access to multiple sources of support from both the Veterans Health Administration and the community.
... however, no changes were observed in fruit consumption. 37 Two other studies conducted in the U.S. found similar results. 38,39 Interventions including CHWs show diverse results regarding body weight change. ...
Introduction:
Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families.
Study design:
Cluster randomized trial conducted between June 2013 and October 2016.
Setting/participants:
A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina.
Intervention:
Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months.
Main outcome measures:
Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017.
Results:
Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000).
Conclusions:
The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina.
Trial registration:
This study is registered at www.clinicaltrials.gov NCT01834131.
... The 4-month intervention (Entre Familia: Reflejos de Salud; Within the Family: Reflections of Health; Ayala et al., 2011) was designed to modify family interactions with regard to dietary behaviors (e.g., parenting practices) through in-home visits and telephone calls from promotoras (community health workers). Results from the intervention have been published elsewhere (Ayala et al., 2015;Horton et al., 2013;Schmied et al., 2014). ...
Background:
Many Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors.
Purpose:
This longitudinal study examined the effect of the family environment on Latina mothers' dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children.
Methods:
Secondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested.
Results:
Less positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children.
Conclusions:
Findings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.
... This study builds on a previous analysis demonstrating that the 4-month intervention significantly decreased fast food intake, and trends were observed in the varieties of vegetables consumed by children [19]. In addition, we found 4-month intervention effects on mothers' reported consumption of vegetables, as well as behavioral strategies to increase fiber and decrease fat intake [20]. In this study, we examined whether the intervention helped to sustain the changes observed at 4-months on varieties of vegetables consumed and weekly consumption of fast food, as well as whether it resulted in new improvements in children's servings of fruits, vegetables and sugar-sweetened beverages, and varieties of fruits consumed at 10 months. ...
... Intervention development [24] was based on the integration of two theoretical frameworks; one focused on behavior change (Social Cognitive Theory [25]) and the second focused on family processes (Family Systems Theory [26]). Details of the intervention are available elsewhere [20]. Table 1 illustrates how these two theories were integrated to design an intervention that focused on the use of positive reinforcement and effective family communication. ...
... Similarly, as we have noted previously, possible demand characteristics, such as wanting to show the positive effects of a promotora-delivered intervention, may explain the positive changes observed among those in the intervention group compared with the control group. We minimized bias by involving trained and blinded evaluation staff, who were separate physically and administratively from the promotoras, to collect the data [20]. Another limitation is the involvement of a convenience and homogenous sample limiting the generalizability of the results. ...
Background:
Few children consume sufficient servings of fruits and vegetables. Interventions aiming to improve children's dietary intake often target parent level factors, but limited research has examined the mediating role of parental factors on children's dietary intake. This study examined 10-month follow up data from the Entre Familia: Reflejos de Salud (Within the Family: Reflections of Health) trial to investigate (1) intervention effects on children's dietary intake, both sustained and new changes, and (2) whether changes in mothers' dietary intake, her parenting strategies, and behavioral strategies to promoting healthy eating in the home mediated changes in children's dietary intake.
Methods:
Participants were 361 Mexican-origin families living in Imperial County, California. Families were randomly assigned to a 4-month dietary intervention or a delayed treatment control group. The intervention was delivered by promotoras (community health workers) via home visits and telephone calls. Assessments occurred at baseline, and 4- and 10-months post-baseline.
Results:
At 10-months post-baseline, sustained intervention effects were observed on children's reported intake of varieties of vegetables, with differences getting larger over time. However, differential intervention effects on fast food were not sustained due to significant reductions in the control group compared with smaller changes in the intervention group. New intervention effects were observed on servings of sugar-sweetened beverages. However, the intervention continued to have no effect on children's reported fruit and vegetable servings, and varieties of fruits consumed. Mother-reported behavioral strategies to increase fiber and lower fat mediated the relationship between the intervention and children's intake of varieties of vegetables. Mothers' percent energy from fat and behavioral strategies to lower fat were mediators of children's daily servings of sugar-sweetened beverages.
Conclusions:
This study suggests that a promotora-led family based intervention can provide mothers with skills to promote modest changes in children's diet. Examining the parent related mechanisms of change will inform future interventions on important targets for improving children's diet.
Trial registration:
https://clinicaltrials.gov/ . NCT02441049 . Retrospectively registered 05.06.2015.
