To implement and evaluate an integrated Spanish-language program to improve nutrition, increase physical activity, and strengthen family function among Mexican-heritage (MH) families. We describe research (stepped wedge cluster randomized controlled trial [SWCRCT] of father-focused, family-centered program), education (experiential learning and innovative teaching), and extension (promotora-led charlas [chats/talks]) components.
The SWCRCT consists of clusters of 10-15 families receiving six in-person group sessions (three focused on father-child pairs) and at-home activities. Session include food tastings, interactive lessons, active games, hands-on food preparation, time to eat together, and goal setting. The promotora interventionists were trained using the train-the-trainer approach to gain knowledge and skills related to nutrition and food preparation, physical activity, family functioning, and motivational interviewing. The program actively involved undergraduate and graduate students from Texas A&M University, Baylor University, and Texas State University in experiential training that included material development, participant observation of promotora trainings (cooking and experiential nutrition and physical activity) and family pretesting, and motivational interviewing. Program activities and learnings were included in undergraduate and graduate courses (research methods and evaluation). In the charla program, team promotoras conducted a series of five community-based programs and activities that delivered science-based knowledge and informal educational programs to empower Mexican-heritage children and families to make sustainable healthy decisions. More than 400 participants attended charlas, which took place in community centers, churches, community organizations, and colonia neighborhoods.
Data were collected for training, recruitment, process (observations and checklists), and outcome (pre- and post-program surveys, seven-day accelerometer, Veggie Meter®, and interviews/focus groups. Surveys and reflection papers from students were used. Post-charla surveys, debriefs, and a follow-up ripple effect survey (sharing of session materials) was done.
Conclusion and Implications
This integrated family program enhances the capacity of families, students, promotoras, and community members to incorporate education and skill-building into healthier behaviors. The SWCRCT is a game changer by engaging Mexican-heritage fathers, co-parenting couples, and children and addresses a lacuna in obesity prevention.