Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low income audience

Institute for Community Health Promotion, Brown University, 1 Hoppin Street, 4th floor, Providence, RI 02903, USA.
Health Education Research (Impact Factor: 1.66). 09/2006; 21(4):465-76. DOI: 10.1093/her/cyh072
Source: PubMed


More effective nutrition education to reach low-income and ethnic minority populations is needed. As part of a project to develop a tailored nutrition education intervention to meet the needs of low-income Hispanics and non-Hispanics, complementary, mixed methods of formative research were used to determine specific characteristics of the target population. The aim was to ensure that the full array of nutrition messages would be comprehensive enough to effectively tailor to the level of the individual. Barriers to healthy eating were delineated for three main dietary behaviors (number of items delineated in parentheses): lowering fat (11), increasing fruit (8) and increasing vegetables (6). Information was also collected regarding motivators for healthy eating (5), situational barriers to making healthy choices (4), other nutrition-related interests (8) and typical eating habits and food-related choices of the target audience.

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Article: Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low income audience

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    • "These findings support those of studies conducted in other populations (11–13,21–23), suggesting that the challenges to healthy eating faced by urban, low-income, minority patients with diabetes are similar to the challenges faced by those without diabetes and those in rural contexts. The present data also support the quantitative findings that healthy eating is difficult in low-income neighborhoods (7–9) and the findings that stress and negative emotion are common in patients with diabetes and adversely affect mental and physical health outcomes (24). "
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    ABSTRACT: OBJECTIVE This study used qualitative interviews with black and Latino participants with diabetes to further understanding about types of foods eaten, food preparation, sources of foods and meals, communication with providers, and effects of race and ethnicity on eating in this population.RESEARCH DESIGN AND METHODS Researchers recruited black and Latino adults from East Harlem, New York, to participate in four English and Spanish focus groups. Discussions were transcribed, coded, and analyzed to uncover prevalent themes, which were interpreted with the Common Sense Model of Self-Regulation.RESULTSThirty-seven adults with diabetes participated in four focus groups. The following four major themes emerged from the analyses: 1) The food environment limited participants' access to healthy foods; 2) understanding of diabetes and communication with clinicians about healthy eating was limited and abstract; 3) the short-term, negative consequences of healthy eating outweighed the benefits; and 4) stress, in large part from poverty and discrimination, was seen as a causal factor for both poor eating and diabetes.CONCLUSIONS Participants' responses indicated that using healthy eating to control diabetes does not provide immediate, tangible results. Thus, these participants followed their own common sense to guide their diabetes management and improve their health. Clinicians may be better able to help patients eat healthfully if they consider these factors during medical visits.
    Diabetes care 07/2013; 36(10). DOI:10.2337/dc12-1632 · 8.42 Impact Factor
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    • "These additional stages encompass any process for eliciting evidentiary, contextual, and target audience and stakeholder barriers and enablers, as part of introducing, designing or redesigning an intervention prior to its widespread implementation. It is proposed that like conventional formative evaluation processes , the translational formative evaluation research should include components such as a synthesis of available evidence; qualitative research with the intended target audience and consultation processes (Glasgow et al., 2003; Strolla et al., 2005; California Department of Public Health, 2012) in addition to situational and environmental analysis to understand the systems in which an up-scaled intervention is to be implemented. Just as conventional formative evaluation methods can be used to design new interventions and guide implementation (Dehar et al., 1993; Stetler et al., 2006; California Department of Public Health, 2012), this paper proposes that the stage of translational formative evaluation is a necessary precursor needed to ensure successful intervention dissemination and provides a case study. "
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    ABSTRACT: The process of generating evidence-based public health interventions is understood to include steps that define the issue, generate and test solutions in controlled settings, replicate and then disseminate more widely. However, to date models have not considered the types and scale of formative evaluation tasks that are needed to up-scale interventions, from efficacy to population-wide dissemination in the real world. In this paper, we propose that an additional stage of 'translational formative evaluation' is necessary for the translation of effectiveness evidence into wide-scale public health practice. We illustrate the utility of translational formative evaluation, through a case study of the Get Healthy Information and Coaching Service® (GHS), a population-based telephone service designed to assist adults change lifestyle-related behaviours. The additional translational formative evaluation steps comprised synthesis of efficacy studies, qualitative research with the wider target audience, environmental analysis and stakeholder consultation. They produced precise recommendations to refine GHS design and implementation. Translational formative evaluation is a necessary intermediate step, following efficacy studies and a precursor to population-wide implementation of public health programmes. © 2013 © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] /* */
    Health Promotion International 04/2013; 29(1). DOI:10.1093/heapro/dat025 · 1.94 Impact Factor
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    • "ple, in telephone survey research with 288 Mexican American adults with Type 2 diabetes (Davis, Peterson, Rothschild, & Resnicow , 2011), the investigators found a relationship between low acculturation and a preference for religious content such as the use of prayer. Quantitative and qualitative methods and behavioral observations can be combined to inform modifications, as in the development of culturally relevant nutrition education programs (Ayala et al., 2001; Buller et al., 2001; Strolla et al., 2006). In a review of randomized controlled trials on diet and exercise interventions with Hispanics, Mier et al. (2010) reported that 44% of the studies used focus groups, literature searches, or surveys to guide culturally sensitive intervention design. "
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    ABSTRACT: Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. Method: Influential literature from the past decade was examined to identify points of consensus. Results: There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. Conclusions: Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 01/2012; 81(2). DOI:10.1037/a0027085 · 4.85 Impact Factor
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