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

摘要 超过三分之二（70.2%）的美国成年人超重或肥胖（体重指数（BMI）≥ 25）。 西班牙裔人肥胖的可能性比白色人高23%， 西班牙裔女性比西班牙裔男性多（分别为45%和39.7%）。5肥胖是由各种社会因素， 身体和经济因素，但主要是由于不良的饮食和身体不活动。 比非西班牙裔白人更有可能从事这些风险行为10 -13鉴于此，最成功的干预措施 降低肥胖指数（例如BMI、体重、腰围）的方法包括饮食和运动21 -23 尽管如此，大多数肥胖研究都是基于一般的非西班牙裔人口。适应文化的健康 与一般方案相比，干预措施大大改善了少数群体的成果26 -30 包括针对西班牙裔的文化定制肥胖计划。31西班牙裔的成功肥胖干预 31依靠健康促进员（也称为社区保健工作者）作为主要执行者。 促销员在提供肥胖干预措施方面是有效的31，37，40，42，然而， 促进者a是有效实施这些干预措施所必需的。一个面对面的培训师 模型是一种值得称赞的投资推广和社区的方式，然而，仍然存在障碍， 由于促销活动的可用性，家庭承诺和相关费用，培训的可及性。43，58 -60我们 目标是为推广人员制定一个有效的、可获得的、可扩展的肥胖预防培训计划。 我们的目标是开发Comadres Saludables，这是一个互动的、基于网络的（和平板电脑兼容的）宣传册a 西班牙裔女性的肥胖预防培训。Comadres Saludables将：1）联合收割机结合理论和 以证据为基础的做法，以提供promotores所需的知识和技能， 为西班牙裔妇女实施肥胖干预; 2）为促进者提供互动的mHealth 工具，以加强与西班牙裔人口的实施。培训计划旨在增加 知识和技能，通过结合互动活动，如互动测验，练习，视频角色- 游戏场景和工具。一个助推单元，旨在为以下方面提供持续的支持和教育： 宣传片也将包括在节目中。最后，交互式移动健康工具将提供给 促进协助执行和忠诚度监测。 在第一阶段，在焦点小组和我们的专家顾问的投入下，伊萨工作人员将开发和试点测试 Comadres Saludables，一个预防肥胖的原型推广培训计划。社区行动 南得克萨斯州公司（CACOST）将向伊萨提供一个咨询委员会，该委员会将参加一个 焦点小组，并在开发原型的迭代过程中提供帮助。此外，CACOST将帮助我们 从该地区招募合格的推广员。经认证的推广人将参加焦点小组， 原型的试点测试。对于第一阶段，介绍、营养和锻炼模块将 大幅度开发，其余模块将部分开发，有足够的材料， 为用户提供一种感觉，即完全开发的程序将包含什么。在第一阶段，我们将与 我们的软件承包商，雷德蒙集团（RGI）开发一个原型程序，由我们的输入指导， 专家顾问、咨询委员会和焦点小组。在我们的原型完成后，我们的团队 专家顾问将对该方案进行最后审查。然后，我们会完成 原型与来自焦点小组的原始参与者。要进入第二阶段，必须有80%的人 无错误率，在试点测试的可用性部分没有关键错误。此外，可行性测试意味着 在建议的原型项目和Comadres Saludables中，必须获得3.5或更高的评级 必须在75%的维度上被评为比可比较的NHLBI培训材料47更可取。我们认为 方案概念的可行性和吸引力将通过使用这两个严格标准来实现。

ABSTRACT More than two in three (70.2%) U.S. adults are overweight or obese (Body Mass Index (BMI) of ≥ 25).1 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).5 Obesity is driven by a variety of social, physical, and economic factors, but is mainly due to poor diet and physical inactivity.2,7 Hispanics are more likely than non-Hispanic Whites to engage in these risk behaviors10-13 Given this, most successful interventions that reduce adiposity indices (e.g. BMI, weight, waist circumference) incorporate both diet and exercise21-23 Nonetheless, most obesity research is based on a general non-Hispanic population. Culturally adapted health interventions substantially improve the outcomes in minority groups compared to generic programs26-30 including culturally tailored obesity programs for Hispanics.31 Successful obesity interventions for Hispanics have relied on promotores de salud (also known as community health workers) as key implementers.31 Promotores are effective in delivering obesity interventions 31,37,40,42, however, adequate in-person training of the promotora is necessary for effective implementation of these interventions. An in-person train-the-trainer model is a laudable means of investing in promotores and communities, however, there remains barriers to accessibility of training due to promotores availability, family commitments and associated costs.43,58-60 Our goal is to develop an effective, accessible, and scalable obesity prevention training program for promotores. We aim to develop Comadres Saludables, an interactive, web-based (and tablet compatible) promotora training for obesity prevention in Hispanic women. Comadres Saludables will : 1) combine both theory and evidence-based practices to provide promotores with the knowledge and skills required to effectively implement an obesity intervention for Hispanic women; and 2) provide promotores with interactive mHealth tools to enhance implementation with Hispanic populations. The training program will aim to increase knowledge and skills by incorporating interactive activities such as interactive quizzes, exercises, video role- playing scenarios, and tools. A booster module aimed at providing continuous support and education for promotores will also be included in the program. Lastly, interactive mHealth tools will be accessible to promotores to aid in implementation and fidelity monitoring. In Phase I, with input from focus groups and our expert consultants, ISA staff will develop and pilot test Comadres Saludables, a prototype promotora training program for obesity prevention. Community Action Corporation of South Texas (CACOST) will provide ISA with an Advisory Committee that will participate in a focus group and aid in the iterative process of developing the prototype. In addition, CACOST will help us recruit certified promotores from the area. Certified promotores will participant in both the focus groups and pilot testing of the prototype. For Phase I, the Introduction, Nutrition, and Exercise modules will be substantially developed, and the remaining modules will be partially developed with sufficient material to provide users with a sense of what the fully developed program will contain. During Phase I, we will work with our software contractor, the Redmon Group (RGI) to develop a prototype program guided by input from our expert consultants, advisory committee, and focus groups. After the completion of our prototype, our team of expert consultants will conduct a final review of the program. We will then complete the pilot testing of the prototype with the original participants from the focus groups. To move to Phase II, there must be an 80% error-free rate and no critical errors in the usability portion of pilot testing. In addition, feasibility testing mean ratings of 3.5 or higher will have to be received across the proposed prototype items and Comadres Saludables must be rated as preferable to comparable NHLBI training materials47 on 75% of the dimensions. We believe that feasibility and appeal of the program concept will be achieved by using these two rigorous criteria.