Deborah Parra-Medina

Compared to the general population in the United States, the Latinx population experiences higher risks for several health conditions including obesity, type 2 diabetes, certain cancers, and depres...

Background: Mobile health apps show promise for delivering physical activity interventions, but uptake remains low due to usability barriers. Beta testing is essential to optimize user experience before full implementation. Objective: This study aimed to evaluate the usability, acceptability, and feasibility of the 50K4Life mobile app prototype for delivering a 2-week walking challenge to public school administrative employees. Methods: Following the Integrate, Design, Assess, and Share framework, we conducted a single-group beta test with 12 public school administrative employees in El Paso County, Texas. Participants used the 50K4Life app built on the Pathverse platform for a 2-week walking challenge. Data collection included acceptability surveys, satisfaction questionnaires, app use metrics, and qualitative debriefing sessions. Results: All 12 participants completed the walking challenge. Acceptability was high for app design (n=12, 91.7%), layout (n=9, 75%), and battery impact (n=10, 83.3% reported no issues). However, participants experienced difficulties with navigation (n=7, 58.3%), delays in updating step counts (n=8, 66.7%), and completion of assigned tasks (n=5, 41.7% could not locate all features). App use was high: 100% (n=12) accessed the leaderboard and walking challenge page, and 91.6% (n=11) synced step data and set step goals. Results from participants’ responses in the surveys and feedback from debrief interviews identified needs for improving user engagement features, synchronization, and visual appeal. Conclusions: The application of a participatory approach and Integrate, Design, Assess, and Share framework yielded valuable insights into the acceptability of the 50K4Life app reported by this study cohort and potential for enhanced features in real-world use contexts.

Childhood obesity disproportionately affects Hispanic children in the United States, with physical inactivity as a major contributor. Hispanic culture emphasizes family ties, positioning parents as key influencers of children’s physical activity (PA). Emerging evidence suggest that children’s PA may shape parental behaviors, such as parents’ provision of support for PA and engagement in PA alongside their child. This study examined bi-directional associations between parental PA support and child PA among Hispanic children with overweight/obesity. Secondary analyses were conducted using three waves of data from the Health4Kids randomized controlled trial, a family-based intervention in Texas with rolling enrollment between June 2015 and August 2018. Participants included 253 Hispanic children ( M _age = 8.75 ± 1.68 years; 50.6% male) with overweight/obesity and one parent (94% mothers). Children wore an ActiGraph GT3X accelerometer for 7 days to measure moderate-to-vigorous PA (MVPA) at baseline, 6 months, and 12 months. Parents completed the Comprehensive Home Environment Survey to assess PA modeling and support at baseline, 6 months, and 12 months. Separate cross-lagged panel models were computed for child MVPA with parental modeling and support. Results revealed a bi-directional relationship between child MVPA and parental support from baseline to 6 months, however, this relationship did not persist from 6 to 12 months. No significant cross-lagged associations were observed between parental modeling and child MVPA across any time points. Findings highlight a bi-directional relationship between parental support and child PA, suggesting that while parental support facilitates child PA, active children may also prompt parents to provide greater support. Parental modeling showed no significant influence on child PA, indicating that direct support may be more impactful than modeling. Overall, results highlight the importance of examining specific parental influences and suggest that parental support may be a critical target for interventions aiming to promote PA among Hispanic children with overweight/obesity.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The high prevalence of type 2 diabetes (T2D) and associated complications disproportionately affect low-income Latino populations, who also experience disparities in diabetes self-management (DSM), including poor medication adherence, physical activity, diet, and glycemic control. Objective: This study examined, through an academic-community partnership, the effectiveness of ¡Salud, Salud! (an evidence-based, family-centered diabetes self-management education and support [DSMES] program) on primary (glycemic control and quality of life) and secondary (social, psychological, and behavioral factors related to T2D management) outcomes among low-income Latino adults with T2D or prediabetes. Methods: In total, 81 adults (mean age 48.90 years, SD 12.57; n=57, 70.4%, female; n=66, 81.5%, Latino) with T2D or prediabetes were enrolled in a 12-week, single-arm quasi-experimental study conducted in two Central Texas Young Men’s Christian Association (YMCA) locations. ¡Salud, Salud! incorporated individual coaching by community health workers (CHWs), online family-centered DSMES training lessons, and a YMCA family membership. The delivery of ¡Salud, Salud! was supported and facilitated by digital technologies, including a dashboard to deliver intervention content and monitor participants’ engagement in intervention activities. Outcomes measured at baseline and 12 weeks (ie, postintervention) included hemoglobin A1c (HbA1c); quality of life; anthropometrics; self-reported physical activity and diet; mindfulness; perceived stress; and diabetes-related knowledge, self-efficacy, and support. Participant engagement in program activities was assessed via four index variables that underlay multiple dimensions of influences on ¡Salud, Salud! uptake: family engagement and support, participation in self-management education, program support and facilitation, and participation in self-monitoring. Paired t-tests and McNemar chi-square tests were used to examine the change in outcomes from baseline to 12 weeks. The number of program activities participants completed for each engagement index variable was converted to percentages to estimate the mean proportion of activities completed. Results: In total, 48 (59.3%) participants completed the 12-week posttest. At the end of the program, participants demonstrated a marginally significant reduction in HbA1c (–0.30%, P≤.09) and a significant increase in participants reporting good-to-excellent health from baseline (n=19, 39.6%) to posttest (n=28, 58.3%; P≤.003). There were significant reductions in body weight (–1.30 kg, P=.02), body fat percentage (–1.26%, P=.01), perceived stress (–0.28, P=.02), added sugar intake (–2.15 teaspoons/day, P=.001), and time spent sedentary per week (–70.27 minutes, P=.003) from baseline to posttest. Mindfulness increased significantly (2.21, P=.01). Participant engagement in ¡Salud, Salud! varied, with participants exhibiting a high completion rate in program support and facilitation activities (88%) and a moderate-to-low completion rate in self-management training (66%), self-monitoring (56%), and family engagement and support (49%) activities. Conclusions: ¡Salud, Salud! shows promising preliminary effects on key diabetes-related outcomes. Future research should investigate how to enhance participant engagement and optimize uptake of evidence-based T2D self-management practices among low-income Latino adults with diabetes.

BACKGROUND The high prevalence of type 2 diabetes (T2D) and associated complications disproportionately affect low-income Latino populations, who also experience disparities in diabetes self-management (DSM), including poor medication adherence, physical activity, diet, and glycemic control. OBJECTIVE This study examined, through an academic-community partnership, the effectiveness of ¡Salud, Salud! (an evidence-based, family-centered diabetes self-management education and support [DSMES] program) on primary (glycemic control and quality of life) and secondary (social, psychological, and behavioral factors related to T2D management) outcomes among low-income Latino adults with T2D or prediabetes. METHODS In total, 81 adults (mean age 48.90 years, SD 12.57; n=57, 70.4%, female; n=66, 81.5%, Latino) with T2D or prediabetes were enrolled in a 12-week, single-arm quasi-experimental study conducted in two Central Texas Young Men’s Christian Association (YMCA) locations. ¡Salud, Salud! incorporated individual coaching by community health workers (CHWs), online family-centered DSMES training lessons, and a YMCA family membership. The delivery of ¡Salud, Salud! was supported and facilitated by digital technologies, including a dashboard to deliver intervention content and monitor participants’ engagement in intervention activities. Outcomes measured at baseline and 12 weeks (ie, postintervention) included hemoglobin A1c (HbA1c); quality of life; anthropometrics; self-reported physical activity and diet; mindfulness; perceived stress; and diabetes-related knowledge, self-efficacy, and support. Participant engagement in program activities was assessed via four index variables that underlay multiple dimensions of influences on ¡Salud, Salud! uptake: family engagement and support, participation in self-management education, program support and facilitation, and participation in self-monitoring. Paired t-tests and McNemar chi-square tests were used to examine the change in outcomes from baseline to 12 weeks. The number of program activities participants completed for each engagement index variable was converted to percentages to estimate the mean proportion of activities completed. RESULTS In total, 48 (59.3%) participants completed the 12-week posttest. At the end of the program, participants demonstrated a marginally significant reduction in HbA1c (–0.30%, P≤.09) and a significant increase in participants reporting good-to-excellent health from baseline (n=19, 39.6%) to posttest (n=28, 58.3%; P≤.003). There were significant reductions in body weight (–1.30 kg, P=.02), body fat percentage (–1.26%, P=.01), perceived stress (–0.28, P=.02), added sugar intake (–2.15 teaspoons/day, P=.001), and time spent sedentary per week (–70.27 minutes, P=.003) from baseline to posttest. Mindfulness increased significantly (2.21, P=.01). Participant engagement in ¡Salud, Salud! varied, with participants exhibiting a high completion rate in program support and facilitation activities (88%) and a moderate-to-low completion rate in self-management training (66%), self-monitoring (56%), and family engagement and support (49%) activities. CONCLUSIONS ¡Salud, Salud! shows promising preliminary effects on key diabetes-related outcomes. Future research should investigate how to enhance participant engagement and optimize uptake of evidence-based T2D self-management practices among low-income Latino adults with diabetes. CLINICALTRIAL

Background: The Childhood Opportunity Index (COI) is a relatively new measure for assessing opportunity across education, health and environment, and socio-economic context. Research indicates that higher COI is associated with lower obesity risk; however, existing research offers no evidence for differences, or lack thereof, across racial/ethnic groups. The larger body of research on the relationship between neighborhood environments and obesity risk among Hispanic children with low-income between 5 and 11-year-olds is limited. The study aims to further explore the relationship between neighborhood opportunities, measured by the COI, and children's body mass index z-scores (BMIz), adjusted for age and sex.Materials and methods: The data are from a sample of Hispanic child-parent dyads (n = 253) who participated in a 1-year family lifestyle intervention. A linear mixed-effects model was fitted, with BMIz as the dependent variable, COI categorized into four levels, time, parent BMI, family income, adult education, child age, child sex, calories, language spoken in the household, physical activity, group condition, and a time*group condition interaction. Predicted probabilities were also produced.Results: After adjusting for covariates, children in the second (β = −.15, 95% CI = −0.27, −0.03), third (β = −.19, 95% CI = −0.31, −0.06), and fourth (β = −.15, 95% CI = −0.28, −0.02) quartiles of the COI quartiles had significantly lower BMIz compared to those in the first (lowest) COI quartile. Predicted probabilities show the different predictive margins of BMIz at each time point for each quartile compared to the first quartile.Conclusions: All the higher COI levels were linked to healthier weight status compared to the lowest COI level, though the pattern was not linear for any of the observed associations. Further investigation into the impact of different COI levels may be warranted to assess each quartile's impact against each other, which was outside the scope of the current study. Results also provide evidence for potentially strengthening intervention supports for those at the lowest COI level, respective to those from all other COI levels.

The growing diversity of the U.S. population, partly due to immigration, has called attention to scholars and practitioners to attend to immigrants' cultural beliefs, values, and ways of doing when designing interventions to promote health and wellbeing. In this paper, we propose a contextual and dynamic model for co‐developing a culturally tailored intervention with the community to advance equity and empowerment of Latinx immigrant caregivers of children with intellectual and developmental disabilities (IDD). Grounded in the literature and voices of the community, the proposed model includes six interactive dimensions (LARREDS) that guided the development of the PODER Familiar intervention described here. These include language and linguistic preferences; accessibility factors; reflecting the group's values, ways of thinking and doing; reflecting generational differences; dimensions of delivery and learning style; and the social, ecological, and cultural environment. Informed by principles of family engagement, the model also includes eight strategies for engaging caregivers throughout the intervention. The conceptual model was co‐developed with promotoras who also provided input on the PODER Familiar intervention. While describing the model in action, we highlight the voices of the promotoras. The implications of culturally tailored interventions and the application of the model to designing interventions for other migrant populations are discussed.

Background/Objectives: This study aimed to adapt evidence-based diabetes self-management education and support (DSMES) into a faith-based (FB) context for Hispanic communities and compare its effectiveness to a faith-placed (FP) approach using the church as a venue for DSMES delivery. Methods: A cluster-randomized trial was conducted among adults with type 2 diabetes from predominantly Hispanic churches. The churches were assigned to either the FB Group (nine churches, n = 146) or the FP Group (seven churches, n = 125). The FB Group, led by trained lay health leaders, received a health sermon, a six-session DSMES program, and a seven-session Healthy Bible Study. The FP Group, led by outside health professionals, received the same six-session DSMES and a seven-session partial attention control curriculum. Key outcomes, including hemoglobin A1c (HbA1c), waist circumference (WC), diabetes distress, self-care activities, and self-efficacy, were assessed at baseline, 6, 9, and 12 months. Results: The FB Group had lower HbA1c levels than the FP Group at 6 months (−0.3%, p < 0.01), with no within-group differences post-intervention. No significant between-group differences were found for other outcomes. Within-group comparisons from baseline showed that both groups reduced WC at 9 and 12 months. Both groups showed reductions in diabetes distress and increased self-efficacy at all time points post-intervention (p < 0.05). The FB Group increased self-care scores at all time points post-intervention, while the FP Group increased at 9 and 12 months. Conclusions: DSMES can be effectively delivered in church settings by trained lay leaders or health professionals in Hispanic communities. Adding a spiritual dimension to DSMES may enhance outcomes.