Natalia Santos

Background: Childhood obesity remains a public health concern in the United States, disproportionately affecting Hispanic/Latino and rural populations. Despite this disparity, there is a lack of culturally relevant programs specifically designed to reach this population. To address this gap, our team culturally adapted a technology-based childhood obesity intervention, Hispanic Family Connections (HFC), targeting Hispanic/Latino families living in rural areas. The intervention comprises 2 main components: interactive voice response (IVR) calls and a workbook with at-home activities to promote family engagement. Objective: The objectives were to (1) evaluate the usability of the IVR calls and workbook included in the HFC intervention and (2) document and plan adaptations to these components using the FRAME (Framework for Reporting Adaptations and Modifications-Enhanced). Methods: We conducted 5 mixed methods, task-based usability tests (UTs) using the think-aloud procedure. All 5 participants were women, self-identified as Hispanic/Latino, and were Spanish literate. Each participant completed 3 think-aloud tasks designed to evaluate the usability of the IVR calls and workbook chapters. Usability was assessed using the After-Scenario Questionnaire (ASQ) at the end of each task and the System Usability Scale (SUS) at the end of the UT session. All sessions were recorded, and data were organized into two primary categories: (1) quantitative results (ASQ and SUS) and (2) qualitative data (participants’ comments and researchers’ observations). Findings were compiled and analyzed following the 8 main domains of FRAME. Results: For the workbook, ASQ scores showed a high level of ease in task completion (mean 1.1, SD 0.32), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.5, SD 0.97). For the IVR calls, participants reported a higher level of ease in task completion (mean 1.0, SD 0.00), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.2, SD 0.45). SUS results were positive for 80% (4/5) of participants, with an average usability score above the benchmark (mean 75.5, SD 15.04). Using FRAME, we identified and documented 30 suggestions for adaptations and improvements to the workbook and IVR calls. The majority of suggestions were content-related (n=26, 86.67%), with most focusing on tailoring/tweaking, or refining existing materials. Conclusions: The UT results, combined with systematic documentation using FRAME, allowed us to identify and prioritize the adaptations needed to improve the intervention materials. These refinements will prepare the HFC intervention for implementation in a subsequent feasibility study.

Resumo Objetivos: Traduzir e adaptar transculturalmente, para o contexto brasileiro, a escala Organizational Readiness to Change Assessment. Métodos: O processo de tradução e de adaptação transcultural ocorreu em seis etapas: 1) anuência do autor da escala original; 2) duas traduções da escala para o português e síntese em uma versão; 3) retrotradução; 4) comitê de avaliação da versão inicial (dez participantes): clareza, compreensão e adequação ao contexto brasileiro; 5) avaliação de especialistas I (mesmos da etapa anterior): avaliação das equivalências semântica, idiomática, cultural e conceitual; 6) avaliação de especialistas II (sete especialistas: cinco regiões do Brasil): avaliação das equivalências semântica, idiomática, cultural e conceitual, considerando variações linguísticas do Brasil, e estabelecimento da versão final. Os especialistas das diferentes etapas eram profissionais com experiência acadêmica ou profissionais da saúde pública. Para as avaliações das etapas 5 e 6, utilizou-se o índice de validade de conteúdo, considerando-se como aceitável uma concordância de pelo menos 80,0% entre os especialistas. Resultados: As 20 questões da escala e seus itens adicionais (totalizando 74 itens para serem respondidos) foram traduzidos e adaptados conforme necessidades identificadas nas diferentes etapas do processo. Nas etapas 5 e 6, as questões dos três domínios da escala (evidência, contexto e facilitação) apresentaram adequada validade de conteúdo. Duas questões apresentaram índice de validade de conteúdo <80,0% em alguma das equivalências. Esses e outros itens com sugestões de alterações foram ajustados, gerando-se a versão final da escala. Conclusão: A escala foi traduzida e adaptada transculturalmente para o contexto brasileiro, apresentando adequada validade de conteúdo.

Objectives: To translate and culturally adapt the Organizational Readiness to Change Assessment scale to the Brazilian context. Methods: The translation and cross-cultural adaptation process took place in six stages: 1) authorization from the author of the original scale; 2) two translations of the scale into Brazilian Portuguese and synthesis into a single version; 3) back-translation; 4) evaluation of the initial version by a review committee (ten participants): clarity, comprehension, and suitability to the Brazilian context; 5) expert assessment I (same participants as the previous stage): evaluation of semantic, idiomatic, cultural, and conceptual equivalences; 6) expert assessment II (seven experts from five Brazilian regions): evaluation of semantic, idiomatic, cultural, and conceptual equivalences, considering linguistic variations in Brazil, and establishment of the final version. The experts involved in the different stages were professionals with academic experience or working in public health. For the assessments in stages 5 and 6, the content validity index was applied, considering agreement of at least 80.0% among experts as acceptable. Results: The 20 questions of the scale and their additional items (a total of 74 items to be answered) were translated and adapted according to the needs identified at different stages of the process. In stages 5 and 6, the questions of the three domains of the scale (evidence, context, and facilitation) demonstrated adequate content validity. Two questions presented a content validity index <80.0% in some equivalences. These and other items for which modifications were suggested were adjusted, resulting in the final version of the scale. Conclusion: The scale was translated and culturally adapted to the Brazilian context, demonstrating adequate content validity.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory GIS mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges.

BACKGROUND Childhood obesity remains a public health concern in the United States, disproportionately affecting Hispanic/Latino (H/L) and rural populations. Despite this disparity, there is a lack of culturally relevant programs specifically designed to reach this population. To address this gap, our team culturally adapted a technology-based childhood obesity intervention, Hispanic Family Connections, targeting H/L families living in rural areas. The intervention comprises two main components: interactive voice response (IVR) calls and a workbook with at-home activities to promote family engagement. OBJECTIVE To 1) evaluate the usability of the IVR calls and workbook included in the Hispanic Family Connections intervention; and 2) document and plan adaptations to these components using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). METHODS We conducted five mixed-method, task-based usability tests (UT) using the think-aloud procedure. All five participants were women, self-identified as H/L, and were Spanish literate. Each participant completed three think-aloud tasks designed to evaluate the usability of the IVR calls and workbook chapters. Usability was assessed using the After Scenario Questionnaire (ASQ) at the end of each task and the System Usability Scale (SUS) at the end of the UT session. All sessions were recorded, and data were organized into two primary categories: 1) quantitative results (ASQ and SUS), and 2) qualitative data (participants' comments and researchers' observational). Findings were compiled and analyzed following the eight main domains of FRAME. RESULTS For the workbook, ASQ scores showed a high level of ease in task completion (1.1 ± 0.32), satisfaction with completion time (1.0 ± 0.00), and satisfaction with support information (1.5 ± 0.97). For the IVR calls, participants reported a higher level of ease in task completion (1.0 ± 0.00), satisfaction with completion time (1.0 ± 0.00), and satisfaction with support information (1.2 ± 0.45). SUS results were positive for 80% of participants, with an average usability score above the benchmark (75.5 ± 15.04). Using FRAME, we identified and documented 30 suggestions for adaptations and improvements of the workbook and IVR calls. The majority of suggestions were content-related (86.67%), with most focusing on tailoring/tweaking, or refining existing materials. CONCLUSIONS The usability test results, combined with the systematic documentation using FRAME, allowed us to identify and prioritize the adaptations needed to improve the intervention materials. These refinements will prepare the Hispanic Family Connections intervention for implementation in a subsequent feasibility study. CLINICALTRIAL Identifier: NCT04731506

Background: Hispanics/Latinos (H/L) are the largest minority group in rural areas in the United States. Although childhood obesity represents a growing burden for this population, there is a lack of culturally relevant interventions designed for Latino children and their families. Objective: This study evaluates the relevance and acceptability of Hispanic Family Connections, a technology-delivered and family-based childhood obesity prevention program for Hispanic/Latino families in rural Nebraska. The program’s materials include a workbook with activities for home completion and interactive voice response (IVR) calls. Methods: A qualitative exploratory study was developed through Focus Groups. Participants were adults who self-identified as H/L, caregivers to children aged 6 to 12, and Spanish literate. A bilingual mediator used a script with 12 questions, based on the project’s conceptual and methodological frameworks: i-PARIHS, Cultural Relevance Questionnaire, and FRAME. We used PowerPoint presentations to share samples of the materials that comprise the Hispanic Family Connection intervention. Sessions were recorded, and we applied thematic content analysis with the support of a codebook based on the constructs of Innovation, Facilitation, Beneficiaries, and Adaptations. Results: Twenty-six H/L who lived in rural Nebraska participated in 8 Focus Groups (FG). We conducted 7 FG in Spanish and 1 in English. Participants highlighted the program’s delivery mode using automated personalized technology, which could give them more freedom to engage. They considered the images and wording culturally relevant and easy to understand. Also, the involvement of all family members was a positive note, with parents working as role models. Factors such as workload and weather conditions could act as barriers to participation. Conclusion: Overall, the intervention was considered relevant among rural Hispanic/Latinos, and the program design and materials were accepted with few adaptations suggested.

Introduction Addressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska. Methods and analysis A mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants’ view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit? Ethics and dissemination This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial. Trial registration number NCT04731506.

Background: The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals’ motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas. Methods: SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona’s IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure – PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications. Results: Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels. Conclusions: Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.