Jorge Luis Motta-Pagán

Background: Overweight and obesity remain major public health challenges in Puerto Rico, affecting over 70% of adults and contributing to cardiovascular, metabolic, and mental health disorders. This study explores the psychosocial and behavioral factors influencing obesity within low-income Puerto Rican communities, emphasizing both biological sex differences and socially defined sex-role influences, along with their respective mental health dimensions. Method: Using a qualitative approach, Community-Based Participatory Research (CBPR), ten focus groups were conducted with 71 participants (37 women and 34 men) from two municipalities in southern Puerto Rico. Discussions were analyzed thematically with the Socioecological and Health Belief Models to identify key determinants. Results: The data collected revealed that women expressed greater emotional vulnerability, frequently citing anxiety, depression, body image concerns, and stress-related eating as contributors to obesity. Men, meanwhile, reported frustration with diet adherence, economic limitations, and healthcare inaccessibility. Across participants, economic hardship, cultural norms, and limited health education emerged as major obstacles. Conclusions: Findings underscore the need for holistic, sex-informed and socially responsive interventions that integrate mental health support with nutritional and physical health strategies. Addressing self-esteem, emotional regulation, and stress management alongside behavioral modification can promote sustainable, culturally tailored obesity prevention in Puerto Rico.

Background: Qualitative research offers a valuable lens for understanding human experiences, behaviors, and social contexts, drawing upon communication, social interaction, and sociological perspectives. Focus groups are a key method within qualitative research for exploring these complex topics. While traditional focus groups offer valuable insights into group dynamics and shared perspectives, they can be limited by logistical challenges, such as geographic constraints and participant availability. To mitigate these issues, virtual modalities have emerged as a viable alternative, offering greater flexibility and accessibility for diverse populations. However, they also highlight persistent challenges, such as managing group dynamics in online settings and ensuring participant engagement and privacy concerns. Our protocol considers these issues and implements strategies, such as cofacilitators, more engaged research assistants, and the use of important security measures (participant name obfuscation, sharing links only on the day of the session, and password protection) as a way to overcome said issues. Objective: Expanding the methods for data collection in qualitative research is essential for advancing health differences research in hard-to-reach populations and public health emergencies. In this paper, we aim to describe our experience when implementing an adapted protocol for conducting virtual focus groups, the barriers encountered, and how we obtained a participation rate of 86% (63/73) compared to 55% () when done in person. Methods: To achieve this, we adapted and implemented a focus group protocol that approaches undersupported populations (social vulnerability index ≥0.45) who face challenges participating in traditional focus groups and addresses reported barriers in scientific literature using virtual focus groups. Our protocol was implemented in an exploratory qualitative study conducted from 2020 to 2021 to understand the community’s health needs in southern Puerto Rico. This protocol ensures participant and research team interactions in circumstances that require it, including pandemics, geographically displaced populations, and patients who are bedridden. After evaluating the practical and ethical considerations, our research team established this new protocol for collecting qualitative data in a virtual focus group environment and promoting the inclusion of groups experiencing health differences. Results: As a result, we collected quality data and found added benefits. We obtained a participation rate of 86% (63/73) compared to 55% () when done in person. Our findings also reveal further benefits that could impact groups that generally do not have the chance to participate in focus groups. Conclusions: This approach to focus groups could aid researchers who wish to study these hard-to-reach participants and support qualitative health differences research.

BACKGROUND Qualitative research offers a valuable lens for understanding human experiences, behaviors, and social contexts, drawing upon communication, social interaction, and sociological perspectives. Focus groups are a key method within qualitative research for exploring these complex topics. While traditional focus groups offer valuable insights into group dynamics and shared perspectives, they can be limited by logistical challenges such as geographic constraints and participant availability. To mitigate these issues, virtual modalities have emerged as a viable alternative, offering greater flexibility and accessibility for diverse populations. However, they also highlight persistent challenges such as managing group dynamics in online settings and ensuring participant engagement and privacy concerns. Our protocol considers these issues and implements strategies such as co-facilitators, more engaged research assistants, and the use of important security measures (numbering participants, sharing links only on the day of the session, and password protection) as a way to overcome said issues. OBJECTIVE Expanding the methods for data collection in qualitative research is essential for advancing health differences research in hard-to-reach populations and public health emergencies. In this article, we aim to describe our experience when implementing an adapted protocol for conducting virtual focus groups, the barriers encountered, and how we obtained a participation rate of 86% compared to 55% when done in person. METHODS To achieve this, we adapted and implemented a focus group protocol that approaches under-supported populations presenting challenges to participate in traditional focus groups and addresses reported barriers in scientific literature using virtual focus groups. Our protocol was implemented in an exploratory qualitative study conducted from 2020 to 2021 to understand the community's health needs in Southern Puerto Rico. This protocol ensures participant and research team interactions in circumstances that require it, including pandemics, geographically displaced populations, and bedridden patients. After evaluating the practical and ethical considerations, our research team established this new protocol for collecting qualitative data in a virtual focus group environment and promoting the inclusion of groups experiencing health differences. RESULTS As a result, we collected quality data and found added benefits. We obtained a participation rate of 86% compared to 55% when done in person. Our findings also reveal further benefits that could impact groups that generally do not have the chance to participate in focus groups. CONCLUSIONS This approach to focus groups could aid researchers who wish to study these hard-to-reach participants and support qualitative health differences research

Integration of the community into health research through community-engaged research has proven to be an essential strategy for reducing health inequities. It brings significant benefits by addressing community health concerns and promoting active community participation in research. The Community Training Institute for Health Disparities (CTIHD) was established to support this integration based on Community-Based Participatory Research (CBPR) principles. The main objective of this paper is to report the CTIHD program’s implementation, evaluation, and outcomes from the first two cohorts. The CTIHD recruited Hispanic community members (N = 54) to be trained in health disparities research and health promotion to foster Community–Academic Partnerships (CAPs) and develop community-led health promotion interventions. Evaluation measures included satisfaction, knowledge change, retention rate, completion rate, and project proposals (research and community health promotion plans). The retention and completion rates were 83% and 78%, respectively, with forty-two (n = 42) community trainees receiving the completion certification. Both cohorts demonstrated a significant increase in knowledge (p < 0.05), and overall satisfaction exceeded 90%. Outcomes include seven (7) community–academic partnerships, leading to the co-development of research proposals, three (3) of which received funding. Additionally, twenty-two (22) community health promotion plans were developed, with seven (7) implemented, impacting 224 individuals. Findings from this study suggest that the CTIHD effectively provided capacity building, promoted the formation of CAPs, and increased community-led health promotion interventions, thereby advancing health disparity research and community initiatives.

The prevalence of chronic medical conditions is associated with biological, behavioral, and social factors. In Puerto Rico (PR), events such as budget cuts to essential services in recent years have contributed to deepening health disparities. This study aimed to explore community perceptions, opinions, and beliefs about chronic health conditions in the southern region of Puerto Rico. Framed by a Community-Based Participatory Research (CBPR) approach, this qualitative study developed eight focus groups (n = 59) with adults (age of 21 or older) from southern Puerto Rico, in person and remotely, during 2020 and 2021. Eight open-ended questions were used for discussions, which were recorded, transcribed, and analyzed via computer analysis. Content analysis revealed four main dimensions: knowledge, vulnerabilities, barriers, and identified resources. Relevant topics included: concerns about mental health—depression, anxiety, substance use, and suicide; individual vulnerabilities—risk behaviors, and unhealthy habits; economic factors—health access and commercialization of health. Resource identification was also explored, and participants discussed the importance of alliances between public and private sectors. These topics were addressed across all focus groups, with various recommendations. The results highlight the importance of prioritizing identified community needs, evaluating available resources, and promoting tailored-made interventions to reduce risk factors for chronic health conditions.