This research proposal addresses health disparities related to physical inactivity and unhealthy diet among rural Latinas. Physical inactivity and unhealthy diet are associated with increased risk of, and morbidity and mortality from, a range of chronic diseases and certain cancers. Engaging in physical activity and eating a healthy diet can reduce the risk for and morbidity and mortality from chronic illness and certain cancers; yet, Latinos in general and rural Latinas in particular are less physically active, eat a less healthy diet and experience a greater prevalence of negative health consequences from these behaviors compared with their non-Latino white and urban counterparts. Because rural Latinas experience unique determinants of physical activity and healthy diet and experience greater disparity in physical inactivity and unhealthy diet, this population needs an intervention designed to address their unique determinants of these behaviors and to begin to diminish these health disparities. Community-based participatory research (CBPR) is an approach that seeks to eliminate health disparities by conducting research with rather than to communities. Using a CBPR approach we propose to use a novel application of intervention mapping, which is a systematic approach that guides program development, to adapt for rural Latinas StrongWomen Healthy Hearts, an exercise and nutrition program designed for rural women. This program has demonstrated significant positive impacts on physical activity, cardiorespiratory fitness and dietary behavior. We are calling the adapted program Fuerte y Sanas (Strong and Healthy).
The specific aims are to: 1) Adapt an effective evidence-based exercise and nutrition program to meet the needs of rural Latinas, 2) Implement the adapted program in a rural Latina population, and 3) Evaluate feasibility and potential to improve physical activity and dietary behavior of the adapted program in a rural Latina population. We will assess feasibility using attendance records, participant and class leader surveys and focus group data. We will measure physical activity with accelerometry, cardiorespiratory fitness with the 12-minute walk test, and dietary behavior with a self-report questionnaire. Descriptive statistics will be calculated. Dependent sample t-tests will be used to examine change scores on physical activity, fitness and dietary behavior outcomes. We will focus on estimating effect sizes and 95% confidence intervals in addition to traditional statistical significance and use these effects sizes in planning a larger study. Quantitative and qualitative results will inform the refinement of the adapted program and development of an implementation study. This study extends the reach of a nationally recognized evidence- based program into an isolated, high need community of rural Latinas and contributes to research aimed at closing the health gap between Latinas and non-Latina white women. Our study will add to implementation science by demonstrating whether the use of intervention mapping to adapt a health promotion program to meet the needs of a particular community is associated with improved behavior outcomes.

Public Health Relevance

Rural Latinas bear a disproportionate burden from physical inactivity and dietary-related negative health consequences. Rural Latinas are less likely than the general population to achieve the recommended diet and amount of physical activity in order to obtain health benefits. We propose to culturally adapt an effective and evidence-based physical activity and nutrition program so that it is meaningful and more likely to be accepted, effective and sustainable with rural Latinas.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Agurs-Collins, Tanya
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Oregon Health and Science University
Schools of Nursing
United States
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