Comadres Saludables: A Web-Based Promotora Training Program for Obesity Prevention in Hispanic Women

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ABSTRACT Hispanics are 23% more likely to be obese than their White counterparts4, and obesity rates are higher in Hispanic women than Hispanic men(45% vs. 39.7, respectively). It is estimated that 77% (or 15.5 million) Hispanic women are overweight or obese. Obesity is driven by a variety of social, physical, and economic factors, but is mainly due to poor diet and physical inactivity. Given this, most successful interventions that reduce adiposity indices (e.g. BMI, weight, waist circumference) incorporate both diet and exercise. Successful obesity interventions for Hispanics utilize cultural tailoring and have relied on promotores de salud (also known as community health workers) as key facilitators in delivering these interventions. Promotores are effective in delivering obesity interventions and promoting behavior change through enhanced motivation, social support, social interaction and connectedness, and self-efficacy. However, adequate in-person promotora training is necessary for effective implementation of these interventions. An in-person train-the-trainer (TTT) model is a laudable means of investing in promotores and communities, yet, there remains barriers to access including family commitments and associated costs. Our goal is to develop an effective, accessible, and scalable eHealth obesity intervention TTT for promotores. Comadres Saludables will combine both theory and evidence-based practices to provide promotores with the self-efficacy, knowledge, and skills required to effectively implement an obesity intervention for Hispanic women. Promotores will build their skillset through interactive quizzes, exercises, and video role-playing scenarios. Additionally, Comadres Saludables will be the first web-based TTT to provide promotores with interactive mHealth tools to enhance implementation with Hispanic women. Specifically, promotores will have the option of texting or emailing program materials directly to the participant and will have access to fidelity monitoring tools to ensure optimal implementation. In Phase I, a prototype of Comadres Saludables was developed, which was informed by formative research conducted with 35 Latina promotores (bilingual) 18-64 years of age. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II we will complete development of the web-based Comadres Saludables training for promotores. In partnership with San Antonio Community Health Workers Association, we will examine the effectiveness of the Comadres Saludables training to increase self-efficacy in implementing effective core lifestyle intervention learning components for obesity interventions in Hispanics. Participants will be randomly assigned to either the intervention condition or to a control condition. Secondary measures will assess demographics, knowledge, attitudes, self-reported skill mastery, satisfaction, and utilization.