Research Article
The Seamos Saludables Study: A Randomized Controlled Physical Activity Trial of Latinas

https://doi.org/10.1016/j.amepre.2013.07.006Get rights and content

Background

Latinas in the U.S. are less physically active than non-Latino white women and also report higher levels of diabetes, obesity, and other conditions related to inactivity. Interventions are needed to address disparities in this high-risk group.

Purpose

To evaluate the efficacy of a culturally adapted, Spanish-language, individually tailored, computer expert system–driven physical activity print-based intervention for adult Latinas.

Design

RCT.

Setting/participants

Participants were 266 inactive adult Latinas who participated between 2009 and 2012.

Intervention

Participants were randomized to one of two treatment arms: a 6-month tailored physical activity intervention condition or wellness contact control. For both conditions, print materials were delivered by mail.

Main outcome measures

The main outcome measure was change in weekly moderate-to-vigorous physical activity (MVPA) measured by the 7-Day Physical Activity Recall interview, which was administered at baseline and post-intervention (6 months). Participants also wore accelerometers for a week at baseline and follow-up. Analyses were conducted in 2013.

Results

Increases in minutes/week of MVPA measured by the 7-Day PAR were significantly greater in the intervention group compared to the control group (mean difference=41.36, SE=7.93, p<0.01). This difference was corroborated by accelerometer readings (rho=0.44, p<0.01). Further, results indicate that intervention participants had greater increases in self-efficacy, cognitive processes, and behavioral processes at 3 months compared to control paricipants (p’s<0.05).

Conclusions

The tailored Spanish-language intervention was effective in increasing MVPA among predominantly low-income, less-acculturated Latinas. Such print-based interventions are poised for widespread dissemination, and thus may help address health disparities.

Introduction

Regular physical activity (PA) is associated with lower morbidity and mortality from heart disease, diabetes, obesity, hypertension, and other chronic diseases.1, 2, 3 Yet PA rates in the U.S. are markedly low.4, 5 Latinos in particular report the highest rates of inactivity (44%) and also suffer disproportionately from conditions linked to sedentary lifestyle, including diabetes, obesity, and metabolic syndrome.5, 6, 7 These disparities represent a significant public health concern and are especially pronounced among Latino women.5 Thus, interventions to increase PA in Latinas are especially needed.

Several PA interventions have targeted Latinas by providing materials and site-based programs in Spanish and/or delivering such interventions through bicultural clinicians or researchers.8 However, retention of and adherence to site-based interventions with Latinas has been challenging,9, 10, 11 along with a number of barriers to participating in PA (e.g., limited transportation, lack of personal free time).12, 13, 14 In one study, 151 Latinas were randomized to Spanish-language dance classes in “store-front” locations near a community clinic or to a safety education control.12 Although the women in the aerobic dance group reported more vigorous exercise and improved fitness compared to those in the control group, the authors noted that continuous rigorous outreach from study staff was necessary to maintain attendance at classes. To be both effective and sustainable, then, PA interventions with this population will likely need to allow for flexibility in time and location of activity, in addition to addressing other unique cultural barriers such as the expectation to put the needs of one’s family before oneself.9, 14

Additionally, few interventions have directly targeted psychosocial constructs shown to predict PA adoption in Latinas, signaling a need for interventions that are both culturally adapted to Latinas and targeted to population-specific, theory-based predictors of PA. Previous research has shown that computer expert system–driven, individually tailored, theory-based print interventions (based on the transtheoretical model and social cognitive theory) can significantly increase PA in predominantly non-Hispanic white individuals.15, 16 These interventions have potential for increasing PA in Latinas, as they can be delivered through the mail, allowing individuals to exercise wherever and whenever it is convenient for them.

In addition, these interventions incorporate theoretic constructs, such as social support and self-efficacy, shown to predict greater activity in Latinas.17, 18, 19 Therefore, formative research was conducted to culturally and linguistically adapt this intervention for Latinas,20 and the adapted intervention was tested (N=93) in a pilot study.21 Results supported the feasibility and acceptability of using such an approach to promote PA in Latinas.21 The objective of the current study was to conduct a fully powered RCT (Seamos Saludables) to test the efficacy of the culturally adapted PA intervention for Latinas.20 It was hypothesized that, after 6 months, women randomized to the intervention arm would report significantly greater increases in weekly moderate-to-vigorous physical activity (MVPA) than those randomized to a wellness contact control condition.

Section snippets

Design

The Seamos Saludables study is an RCT of a 6-month culturally and linguistically adapted, individually tailored PA print intervention for Latinas versus a wellness contact control condition. Data were collected between 2009 and 2012. The primary dependent variable is self-reported weekly PA at baseline and 6 months as measured by the 7-Day Physical Activity Recall (7-Day PAR; for more detailed information on the design, see Pekmezi et al.20).

Setting and Sample

The study was conducted at the Institute for

Results

Table 1 presents baseline characteristics of the sample, both overall and by intervention arm. Among the 266 women randomized at baseline, the average age was 40.67 years (SD=9.98) and mean BMI was 29.40 (SD=4.70). More than 90% were first-generation immigrants to the U.S., and >81% spoke only Spanish or more Spanish than English, suggesting that the group was low in acculturation. The majority were of Caribbean or South-American descent, with the largest groups being Dominican (37%) and

Discussion

Findings support the efficacy of this technology-based approach to promoting physical activity in Latinas. As hypothesized, both self-report and objective data show that women randomized to the intervention group reported significantly greater increases in weekly MVPA after 6 months than those randomized to the wellness control condition. Effect sizes were relatively unchanged after removing occupational activity, suggesting that changes were primarily in leisure-time PA. The increase in

Acknowledgments

This research was supported by the National Institute of Nursing Research at the NIH (Grant NR011295). The authors thank collaborators Drs. Christina Lee, Charles Neighbors, Ernestine Jennings, and Ronnesia Gaskins for earlier contributions to this study. The authors thank Susan Carton-Lopez, Viveka Ayala-Heredia, Susan Pinheiro, Jane Wheeler, Jamie Longval, Jacqueline Parra, Joshua Marcus-Blank, and Rebecca Levenson of Brown University as well as Raul Fortunet and Rachelle Edgar of the

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