Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing
Abstract
Purpose
To determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention.
Design
Quasi-experimental evaluation.
Setting
El Paso, Texas.
Sample
Among 656 baseline participants, 374 (54%) completed the 12-month assessment.
Intervention
In Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions.
Measures
CHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale.
Analysis
Regression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment.
Results
Participants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months.
Conclusion
Findings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.
Get full access to this article
View all access and purchase options for this article.
References
1. Wheeler SM, Bryant AS. Racial and ethnic disparities in health and health care. Obstet Gynecol Clin North Am. 2017;44(1):1-11.
2. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: The effect of overweight and obesity on advancing death. Am J Publ Health. 2014;104(3):512-519.
3. Chan RSM, Woo J. Prevention of overweight and obesity: how effective is the current public health approach. Int J Environ Res Public Health. 2010;7:765-783.
4. Bautista L, Reininger B, Gay JL, Barroso CS, McCormick JB. Perceived barriers to exercise in Hispanic adults by level of activity. J Phys Activ Health. 2011;8:916-925.
5. Alidu L, Grunfeld EA. A systematic review of acculturation, obesity and health behaviours among migrants to high-income countries. Psychol Health. 2018;33:724-745.
6. New C, Xiao L, Ma J. Acculturation and overweight-related attitudes and behavior among obese hispanic adults in the United States: acculturation and obesity in US Hispanics. Obesity. 2013;21:2396-2404.
7. Im E-O, Lee B, Hwang H, et al. “A waste of time”: Hispanic women's attitudes toward physical activity. Women Health. 2010;50:563.
8. Shedlin MG, Decena CU, Mangadu T, Martinez A. Research participant recruitment in Hispanic communities: lessons learned. J Immigr Minor Health. 2011;13:352-360.
9. Balcazar H, Rosenthal EL, Brownstein JN, Rush CH, Matos S, Hernandez L. Community health workers can be a public health force for change in the United States: three actions for a new paradigm. Am J Publ Health. 2011;101:2199-2203.
10. Rosenthal EL, Brownstein JN, Rush CH, et al. Community health workers: part of the solution. Health Aff. 2010;29(7):1338.
11. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399-421.
12. Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. Am J Publ Health. 2017;107:1660-1667.
13. Dearing JW. Applying diffusion of innovation theory to intervention development. Res Soc Work Pract. 2009;19:503-518.
14. Mack M, Uken R, Powers J. People improving the community’s health: community health workers as agents of change. J Health Care Poor Under. 2006;17:16-25.
15. Mobula LM, Okoye MT, Boulware LE, Carson KA, Marsteller JA, Cooper LA. Cultural competence and perceptions of community health workers’ effectiveness for reducing health care disparities. J Prim Care Comm Health. 2015;6:10-15.
16. Tovar A, Renzaho AM, Guerrero AD, Mena N, Ayala GX. A systematic review of obesity prevention intervention studies among immigrant populations in the US. Curr Obes Rep. 2014;3:206-222.
17. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12:709-723.
18. McNeil DW, Addicks SH, Randall CL. Motivational Interviewing and Motivational Interactions for Health Behavior Change and Maintenance. New York: Oxford University Press; 2017.
19. Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;5:Cd008066.
20. Miller WR, Moyers TB. Eight stages in learning motivational interviewing. J Teach Addict. 2006;5:3-17.
21. Resnicow K, McMaster F. Motivational interviewing: moving from why to how with autonomy support. Int J Behav Nutr Phys Activ. 2012;9:19.
22. Brandford A, Adegboyega A, Combs B, Hatcher J. Training community health workers in motivational interviewing to promote cancer screening. Health Promot Pract. 2019;20:239-250.
23. Dilillo V, West DS. Motivational interviewing for weight loss. Psychiatr Clin. 2011;34:861-869.
24. Reinschmidt K, Hunter J, Lacy-Martínez C. Understanding the success of promotoras in increasing chronic disease screening. J Health Care Poor Under. 2006;17:256-264.
25. Group TLAR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the look ahead trial. Arch Intern Med. 2010;170:1566-1575.
26. West DS, Dilillo V, Bursac Z, Gore SA, Greene PG. Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care. 2007;30:1081-1087.
27. Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One. 2018;13(10):e0204890.
28. Brown LD, Vasquez D, Salinas JJ, Tang X, Balcazar H. Evaluation of healthy fit: A community health worker model to address Hispanic health disparities. Prev Chronic Dis. 2018;15:170347.
29. Barnett JC, Berchick E. Health Insurance Coverage in the United States: 2016. Washington, DC: US Census Bureau; 2017.
30. Paso del Norte Health Foundation. Healthy Paso del Norte: Disparities Dashboard [Internet]; 2020. http://www.healthypasodelnorte.org/index.php?module=indicators&controller=index&action=dashboard&id=83017179230228502&card=0&localeId=2645. Accessed May 27, 2020.
31. American Heart Association. Understanding Blood Pressure Readings [Internet]. WVavKIjyvRZ; 2020. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#. Accessed May 27, 2020.
32. Balcázar HG, Heer HD, Thomas SW, et al. Promotoras can facilitate use of recreational community resources: The Mi Corazón Mi Comunidad cohort study. Health Promot Pract. 2016;17:343-352.
33. Moyers TB, Rowell LN, Manuel JK, Ernst D, Houck JM. The motivational interviewing treatment integrity code (MITI 4): Rationale, preliminary reliability and validity. J Subst Abuse Treat. 2016;65:36-42.
34. Hamilton CM, Strader LC, PJ G, et al. The PhenX toolkit: get the most from your measures. Am J Epidemiol. 2011;174:253-260.
35. Cantor SB, Byrd TL, Groff JY, Reyes Y, Tortolero-Luna G, Mullen PD. The language translation process in survey research: a cost analysis. Hisp J Behav Sci. 2005;27:364-370.
36. Masterson Creber RM, Fleck E, Liu J, Rothenberg G, Ryan B, Bakken S. Identifying the complexity of multiple risk factors for obesity among urban Latinas. J Immigr Minor Health. 2017;19:275-284.
37. Zheng R, Du M, Zhang B, et al. Body mass index (BMI) trajectories and risk of colorectal cancer in the PLCO cohort. Br J Cancer. 2018;119(1):130-132.
38. Hills AP, Byrne NM, Lindstrom R, Hill JO. Small changes’ to diet and physical activity behaviors for weight management. Obes Facts. 2013;6(3):228-238.
39. Lasikiewicz N, Myrissa K, Hoyland A, Lawton CL. Psychological benefits of weight loss following behavioural and/or dietary weight loss interventions. A systematic research review. Appetite. 2014;72:123-137.
40. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: Differences at 5%, 10%, 15%, and over. Current Obesity Reports. 2017;6(2):187-194.
41. Lopez DI, Chacon L, Vasquez D, Brown LD. Body composition outcomes of Healthy Fit and the role of acculturation among low-income Hispanics on the US-Mexico border. BMC Publ Health. 2021;21(1):976.
42. Eakin EG, Winkler EA, Dunstan DW, et al. Living well with diabetes: 24-month outcomes from a randomized trial of telephone-delivered weight loss and physical activity intervention to improve glycemic control. Diabetes Care. 2014;37:2177.
43. Portillo EM, Vasquez D, Brown LD. Promoting hispanic immigrant health via community health workers and motivational interviewing. Int Q Community Health Educ. 2020;41:3-6.
44. Resnicow K, Diiorio C, Soet JE, Borrelli B, Hecht J, Ernst D. Motivational interviewing in health promotion: it sounds like something is changing. Health Psychol. 2002;21:444-451.
45. Ingram M, Doubleday K, Bell ML, et al. Community health worker impact on chronic disease outcomes within primary care examined using electronic health records. Am J Publ Health. 2017;107:1668-1674.
46. Kim DD, Basu A. Estimating the medical care costs of obesity in the United States: systematic review, meta-analysis, and empirical analysis. Value Health. 2016;19(5):602-613.
47. Tseng E, Zhang A, Shogbesan O, et al. Effectiveness of policies and programs to combat adult obesity: a systematic review. J Intern Med. 2018;33:1990-2001.
Cite article
Cite article
Cite article
OR
Download to reference manager
If you have citation software installed, you can download article citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: November 18, 2021
Issue published: February 2022
Keywords
PubMed: 34791885
Authors
Metrics and citations
Metrics
Journals metrics
This article was published in American Journal of Health Promotion.
VIEW ALL JOURNAL METRICSArticle usage*
Total views and downloads: 676
*Article usage tracking started in December 2016
Articles citing this one
Receive email alerts when this article is cited
Web of Science: 2 view articles Opens in new tab
Crossref: 0
-
Evaluating the Dissemination and Implementation of a Community Health ...
Figures and tables
Figures & Media
Tables
View Options
Get access
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
loading institutional access options
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
