Dietary and Physical Activity Behavioral Intervention Vivamos Activos
Dietary and Physical Activity Behavioral Intervention
Vivamos Activos
Public Health Problem: Obesity in Starr County
Intervention: Vivamos Activos Theory Project Management Budget Evaluation Sustainability Limitations, Challenges, Policy Implications
What’s Next?
TODAY’S AGENDA
In the United States, 33.8% adults (CDC, 2011)
In Texas, 66.8% of adults are either obese or overweight (DSHS, 2010)
In Starr County, 27.1% of adults are obese (Find
Data, 2012) 95.7% of residents are Hispanic 25% of the population has health
insurance (Census, 201
PREVALENCE OF OBESITY
Obesity related health concerns: Diabetes Heart disease Sleep apnea Hypertension Lower quality of life (Edward, 2010)
Built EnvironmentSleepCulture:
Hispanic population Familismo
HEALTH CONCERNS AND FACTORS THAT EFFECT
OBESITY
Implementers: Health Department in Rio
Grande City
Addresses the individual and environmental
influences of obesity in Starr County, TX
INTERVENTION: VIVAMOS ACTIVOS
Individual Influences:• Gender• Ethnicity
• Socioeconomic status
• Sleeping habits• Biological toxins
Environmental Influences:
•Community promotion of food intake
• Availability of healthy food
• Access to physical activity
• Socioeconomic status of Starr County• Family Unit
THEORY
Behavioral counseling intervention Emphasizes healthy eating and exercise Teaches to manage emotional distress Progresses participants into action/maintenance Stage of Change (Johnson et al, 2008)
Targets Hispanic women Culturally appropriate Capitalizes on a woman’s influence on the
household Disseminates information to family unit
(Galanti, 2003)
WHAT IS VIVAMOS ACTIVOS?
Counseling:Four individual/family counseling sessionsNine group sessions
Goals:1. Decrease BMI
a. Increase physical activityb. Increase healthy eating
VIVAMOS ACTIVOS CONT.
VIVAMOS ACTIVOS: SCHEDULE
Month 1-6 Month 7-12 Month 12-17Group Session 1
Group Session 2Group Session 3Group Session 4Group Session 5Group Session 6Group Session 7Group Session 8Group Session 9
Group Session 10Group Session 11Group Session 12
Group Session 13Group Session 14Group Session 15
Individual Session 1Individual Session 2
Individual Session 3
Individual Session 4
PROJECT MANAGEMENT: STAFF
Project Director
Nursing Staff Counselor
Community Health Worker
Community Health Worker
Counselor
Community Health Worker
Comunity Health Worker
STUDY TIMELINE
Quasi Experimental study specifically a Non-Equivalent Groups Design with aspects of a Time-Series Design
3 ½ Year Timeline
2 Groups Intervention: Roma Family Clinic
Receives Vivamos Activos intervention Control: Nuestra Clinica del Valle
Receives health education and nutrition advise from dieticians at Federally Qualified Health Center
STUDY DESIGN
Study Population: 630 Hispanic Women Ages 18+ BMI > 25
Recruitment: Where:
Two Federally Qualified Health Clinics Nuestra Clinica del Valle in Rio Grande City, TX Roma Family Clinic in Roma, TX
How: Nurses will identify women patients with a BMI >25
and refer them to Vivamos Activos Community Health Workers
STUDY POPULATION & RECRUITMENT
INTERVENTION BUDGET
Total amount: $300,000
2 year timeframe
Major costs: Personnel Operating Expenses Contractual Travel Program Costs Personnel
83%
Operating Costs2%
Contractual1%
Program Costs11%
Travel3%
Primary question: Is there a reduction in obesity among program
participants, who completed Vivamos Activos?Secondary questions:
Do participants eat healthier?Did program participants increase their physical activity?
Sample size calculation ~ 320 people in both the intervention and control groups After attrition, a sample size of ~160 people in
both the intervention and control groups
EVALUATION METHODOLOGY
Qualitative Collected through means of survey questionnaires Questions include topics related to:
Demographic history Employment/Income Physical activity Nutrition assessment Smoking habits Alcohol consumption Medication usage
EVALUATION: PREDICTOR VARIABLES
Quantitative
Collected initially by Vivamos Activos staff
Measurements:
Body Mass Index (BMI)
Waist-to-Height Ratio (WHtR)
Outcome Variables
Plausibility
Benefits
Limitations
EVALUATION: OUTCOME
VARIABLES
Parametric Tests
Two sample t-test
Linear regression
Adjustments
Stratification
EVALUATION: STATISTICAL ANALYSIS
Total amount: ???
1 ½ year timeframe
Major Costs: Personnel Operating Expenses Travel Program Costs
EVALUATION BUDGET
Personnel94%
Operating Costs4%
Program Costs2%
FQHCs are funded by Medicare to provide: Medical Social Services such as cultural implications, health
education, and counseling Weight Measurements Risk Assessment and Counseling
Vivamos Activos can be implemented and funded by the services already provided Their services will require change to fit Vivamos Activos
guidelines
Starr County can have a permanent intervention in place to mitigate the prevalence of obesity.
SUSTAINABILITY
Study Design Lack of randomization Sampling bias Residual confounding Threat to internal validity Retention of participants Generalizability
Coordination of effective communication among stakeholders
Level of competency of staff Community health workers have limited training delivering
counseling & lack technical abilities to address determinants
Diffi culty engaging participant’s family members in counseling sessions
LIMITATIONS
If successful, we recommend that Vivamos Activos become a policy change, to be implemented by
Federally Qualified Health Clinics who serve primarily a Hispanic population.
WHAT’S NEXT?
QUESTIONS?
U . S . C e n s u s B u r e a u . ( 2 0 1 2 ) A m e r i c a n Fa c t Fi n d e r 2 0 1 0 D e m o g r p a h i c P r o fi l e D a t a . h t t p : / / f a c t fi n d e r 2 . c e n s u s . g o v / f a c e s / t a b l e s e r v i c e s / j s f / p a g e s / p ro d u c t v i e w. x h t m l ? p i d = D E C _ 1 0 _ D P _ D P D P 1 & p ro d Ty p e = t a b l e
Fi n d T h e D a t a . ( 2 0 1 2 ) S t a r r C o u n t y , Tex a s O b e s i t y R a t e s a n d Fa s t Fo o d C o n s u m p t i o n .
h t t p : / / c o u n t y - f o o d . fi n d t h e d a t a . o rg / l / 2 7 3 4 / S t a r r D S H S . ( 2 0 1 0 ) Tex a s O v e r w e i g h t a n d O b e s i t y S t a t i s t i c s . O b e s i t y D a t a S h e e t . Tex a s D e p a r t m e n t o f
S t a t e H e a l t h S e r v i c e s . C D C . ( 2 0 1 1 ) O v e r w e i g h t a n d O b e s i t y. U . S . O b e s i t y Tr e n d s .
h t t p : / / w w w. c d c . g o v / o b e s i t y / d a t a / t r e n d s . H T M L S l a t e r r y , M . L . , S w e e n e y , C . , E d w a rd s , S . , H e r r i c k , J . , M u r t a u g h , M . , B a u m g a r t n e r , K . , . . B y e r s , T. ( 2 0 0 6 ) .
P h y s i c a l Ac t i v i t y Pa t t e r n s a n d O b e s i t y i n H i s p a n i c a n d n o n - H i s p a n i c W h i t e Wo m e n . M e d i c i n e a n d S c i e n c e i n S p o r t s a n d E xe r c i s e , 3 3 - 4 1 .
Tr u s t f o r A m e r i c a ’ s H e a l t h ( 2 0 1 1 ) . F a s i n f a t : h o w o b e s i t y t h r e a t e n s A m e r i c a ’ s f u t u r e 2 0 1 1 .
h t t p : / / h e a l t h y a m e r i c a n s . o r g / a s s e t s / fi l e s / T FA H 2 0 1 1 Fa s I n Fa t 1 0 . p d f Tex a s D e p a r t m e n t o f S t a t e H e a l t h S e r v i c e s ( 2 0 0 5 ) . E a t s m a r t , b e a c t i v e . S t r a t e g i c p l a n f o r t h e i n t e r v e n t i o n
o f o b e s i t y i n Te x a s 2 0 0 5 - 2 0 1 0 . w w w. g o o g l e . c o m / u r l ? s a = t & rc t = j & q = & e s r c = s & s o u r c e = w e b & c d = 1 & v e d = 0 C . . .
Ka h n , Ka t e r i n e A . ( 2 0 0 8 ) A m e r i c a n Ac a d e m y o f Pe d i a t r i c s 2 0 0 8 N a t i o n a l C o n f e r e n c e a n d E x h i b i t i o n . S c h o o l -
B a s e d P h y s i c a l A c t i v i t y I n t e r v e n t i o n s I n e ff e c t i v e f o r C h i l d h o o d O b e s i t y. P re s e n t e d O c t o b e r 1 2 , 2 0 0 8 . Lo p e z & H y n e s . ( 2 0 0 6 ) B i o M e d C e n t r a l L t d . O b e s i t y, P h y s i c a l A c t i v i t y, a n d t h e U r b a n E n v i r o n m e n t : P u b l i c
h e a l t h R e s e a r c h N e e d s . h t t p : / / w w w. e h j o u r n a l . n e t / c o n t e n t / 5 / 1 / 2 5 M c A l l i s t e r , E . J . , D h u r a n d h a r , N . V. , Ke i t h , S . W. , A r o n n e , L . J . , B a rg e r , J . , B a s k i n , M . , . . . A l l i s o n , D . B .
( 2 0 0 9 ) . Te n p u t a t i v e c o n t r i b u t o r s t o t h e o b e s i t y e p i d e m i c . C r i t i c a l R e v i e w s i n F o o d S c i e n c e a n d N u t r i t i o n , 4 9 , 8 6 8 - 9 1 3 . d o i : 1 0 . 1 0 8 0 / 1 0 4 0 8 3 9 0 9 0 3 3 7 2 5 9 9
G a l a n t i , G . ( 2 0 0 3 ) . T h e H i s p a n i c f a m i l y a n d m a l e - f e m a l e r e l a t i o n s h i p s : A n o v e r v i e w. J o u r n a l o f Tr a n s c u l t u r a l N u r s i n g , 1 4 ( 3 ) , 1 8 0 - 1 8 5 . d o i : 1 0 . 1 1 7 7 / 1 0 4 3 6 5 9 6 0 3 0 1 4 0 0 3 0 0 4
SOURCES