Mujeres Fuertes y Corazones Saludables, a Culturally Tailored Physical Activity and Nutrition Program for Rural Latinas: Findings from a Pilot Study.

In the United States, Latino adults, compared with non-Hispanic white adults, are less likely to meet physical activity and dietary recommendations, and have higher rates of obesity. There is an urgent need for culturally adapted health promotion programs that meet the needs of the growing Latino population in the United States. We systematically adapted StrongWomen-Healthy Hearts, an evidence-based physical activity and nutrition program, for rural Latinas. This paper reports results from a pilot study of the adapted program. We used mixed methods to assess the feasibility and efficacy of the adapted program, Mujeres Fuertes y Corazones Saludables, in a nonprofit community organization serving rural Latinos. The intervention consisted of sixty-minute classes held twice weekly for 12 weeks and included 30 minutes of physical activity and 30 minutes of nutrition education. To assess efficacy, we used a one-group, pre⁻post design with overweight/obese, sedentary, middle-aged or older, Spanish-speaking rural Latinas (n = 15). Outcome measures included weight, height, body mass index (BMI), waist circumference, cardiorespiratory fitness, physical activity, dietary behavior, and self-efficacy for diet and physical activity. Process outcomes included attendance, end of class surveys, mid-program evaluation survey, and a post-program focus group. We calculated means and standard deviations, paproired t-tests, and Cohen's D effect size. Qualitative data were analyzed using qualitative description. Significant changes pre- to post-program included weight (-1.5 kg; p = 0.009), BMI (-0.6; p = 0.005), waist circumference (-3.0 cm; p = 0.008), 6-minute walk test (69.7 m; p < 0.001), frequency of sugar-added drink consumption (-0.7 servings; p = 0.008), fruit and vegetable intake (1.3 servings; p = 0.035), and physical activity self-efficacy (0.9 points; p = 0.022). Participants found the program motivating and enjoyable, and on average participants attended 62% of classes and fidelity was maintained. This pilot study suggests that this culturally adapted physical activity and nutrition program for rural Latinas shows promise in improving physical activity, diet, and obesity.

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

OBJECTIVES: (1) To assess providers' experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers' utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations. METHODS: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. RESULTS: The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers' profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9). CONCLUSIONS: Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.

Mujeres Fuertes y Corazones Saludables: adaptation of the StrongWomen -healthy hearts program for rural Latinas using an intervention mapping approach.

OBJECTIVE: To describe our use of intervention mapping as a systematic method to adapt an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. METHODS: An intervention mapping process involving six steps guided the adaptation of an evidence based physical activity and nutrition program, using a community-based participatory research approach. We partnered with a community advisory board of rural Latinas throughout the adaptation process. RESULTS: A needs assessment and logic models were used to ascertain which program was the best fit for adaptation. Once identified, we collaborated with one of the developers of the original program (StrongWomen - Healthy Hearts) during the adaptation process. First, essential theoretical methods and program elements were identified, and additional elements were added or adapted. Next, we reviewed and made changes to reflect the community and cultural context of the practical applications, intervention strategies, program curriculum, materials, and participant information. Finally, we planned for the implementation and evaluation of the adapted program, Mujeres Fuertes y Corazones Saludables, within the context of the rural community. A pilot study will be conducted with overweight, sedentary, middle-aged, Spanish-speaking Latinas. Outcome measures will assess change in weight, physical fitness, physical activity, and nutrition behavior. CONCLUSIONS: The intervention mapping process was feasible and provided a systematic approach to balance fit and fidelity in the adaptation of an evidence-based program. Collaboration with community members ensured that the components of the curriculum that were adapted were culturally appropriate and relevant within the local community context.