Jeannie Aguirre-Hernández

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.

The adoption of Community-Based Participatory Research (CBPR) approaches has increased due to its potential to reduce health disparities through Community-Academic Partnerships (CAP). Providing community members (CM) capacity-building opportunities is a way of empowering communities and promoting social change. To support the development of CAPs, the Community Training Institute for Health Disparities (CTIHD) was created in southern Puerto Rico to capacitate community leaders in the CBPR approach and basic research knowledge through the CTIHD-Community Research Program (CRP). In 2019, six syllabi-led courses were developed and implemented utilizing a problem-based curriculum design and competency-based learning model, with 12 community members enrolled. A mixed methodology assessed satisfaction, acceptance, feasibility, retention rate, and knowledge change from cognitive debriefing with semi-structured questions (qualitative), course evaluations, attendance, program documents, and pre-and post-tests (quantitative). Results indicate high levels of satisfaction from courses and retention rates of 100% and 91%, respectively. Post-course evaluation scores exceeded 70% in five of six courses, with two courses demonstrating statistically significant results ( p < .05). Cognitive debriefing results indicate the feasibility and acceptability of the curriculum with suggested modifications in practical applications, itinerary of courses, and research proposal development. The outcomes of the program include the formation of four partnerships and the development of three research proposals. Capacity-building efforts, such as those of the CTIHD-CRP, are essential to increase community participation in health research, foster the formation of Community-Academic Partnerships (CAPs), and support the development of research on health disparities in the long-term.