Challenges and opportunities in establishing a collaborative multisite observational study of chronic diseases and lifestyle factors among adults in Puerto Rico

Abstract

BackgroundPrevalence of chronic diseases and unhealthy lifestyle behaviors among the adult population of Puerto Rico (PR) is high; however, few epidemiological studies have been conducted to address these. We aimed to document the methods and operation of establishing a multisite cross-sectional study of chronic diseases and risk factors in PR, in partnership with academic, community, clinical, and research institutions.MethodsThe Puerto Rico Assessment of Diet, Lifestyle and Diseases (PRADLAD) documented lifestyle and health characteristics of adults living in PR, with the goal of informing future epidemiological and intervention projects, as well as public health, policy, and clinical efforts to help improve the population’s health. The study was conducted in three primary care clinics in the San Juan, PR metropolitan area. Eligible volunteers were 30–75y, living in PR for at least 10 months of the previous year, and able to answer interviewer-administered questionnaires without assistance. Questions were recorded electronically by trained interviewers, and included socio-demographic characteristics, lifestyle behaviors, self-reported medically-diagnosed diseases, and psychosocial factors. Waist and hip circumferences were measured following standardized protocols. A subset of participants answered a validated food frequency questionnaire, a legumes questionnaire, and had medical record data abstracted. Process and outcome evaluation indicators were assessed.ResultsThe study screened 403 participants in 5 months. Of these, 396 (98%) were eligible and 380 (94%) had reliable and complete information. A subset of 242 participants had valid dietary data, and 236 had medical record data. The mean time to complete an interview was 1.5 h. Participants were generally cooperative and research collaborators were fully engaged. Having multiple sites helped enhance recruitment and sociodemographic representation. Diagnosed conditions were prevalent across sites. Challenges in data monitoring, interviewer training, and scheduling were identified and corrected, and should be addressed in future studies.ConclusionsEpidemiological studies in PR can be successfully implemented in partnership with multiple institutions. Effective recruitment and implementation requires concerted planning and continued involvement from partners, frequent quality control, brief interviews, reasonable incentives, and thorough training/re-training of culturally-sensitive interviewers. Further studies are feasible and needed to help address highly prevalent chronic conditions in PR.

Health conditions and lifestyle risk factors of adults living in Puerto Rico: a cross-sectional study

“…The convenience sampling in primary clinics from the San Juan metropolitan area reduces the generalizability of our results, and it is possible that those seeking primary care services were either more health-conscious or needed clinical care due to pre-existing conditions. However, health insurance coverage in Puerto Rico is high, thus most people had access to care in the recruitment clinics, and their diverse locations improved the sociodemographic representation of our sample [ 12 ]. The prevalence of chronic conditions reported in our study were similar to those reported by BRFSS and previous studies, suggesting that we captured accurate occurrence of disease among adults.…”

“…The Puerto Rico Assessment of Diet, Lifestyle, and Diseases (PRADLAD) study is a cross-sectional survey of a convenience sample of 380 adults living in Puerto Rico, conducted in 2015 with the goal of assessing lifestyle risk factors and health conditions among adults in the island. Study design and methodology have been described in detail previously [ 12 ]. Participants were patients waiting for a medical appointment, or visitors, recruited from three primary care clinics (a community clinic ( n = 206); a research-based clinic ( n = 101); and a city hospital clinic ( n = 73), selected for their strategic locations, facilities, and wide patient representation) in the San Juan metropolitan area.…”

Dietary Intake and Its Determinants Among Adults Living in the Metropolitan Area of Puerto Rico

“…Data were analyzed from the cross-sectional survey Puerto Rico Assessment of Diet, Lifestyle, and Diseases (PRADLAD). Details of the study recruitment and procedures have been previously described [19]. Briefly, between July and November 2015, a convenience sample of adults living in the San Juan, PR metropolitan area was recruited by advertising at three partner clinics: a research center and medical care facility, a primary care clinic within a city hospital, and a nonprofit federally-funded primary community health care center.…”

Examination of the impact of environmental and dietary exposures on the health of Puerto Ricans

“…The Hispanic Community Health Study gave specific guidance towards focusing on preventive risk factors that are culturally tailored to specific Hispanic groups (Daviglus, Pirzada, & Talavera, 2014), a call echoed by other researchers studying Puerto Ricans (Mattei et al, 2017). By researching and gaining knowledge about Puerto Rican environment, diet and gut microbiome, we build a greater understanding of the comprehensive exposures and intermediaries that compromise Puerto Rican health.…”

“…Ricans (Mattei et al, 2017;. This minority group is disadvantaged in terms of their socioeconomic status, and several lifestyle exposures (Lucas, Freeman, & Adams, 2016;Martell, Garrett, & Caraballo, 2016), that contributes to but does not adequately explain their many health disparities when compared to whites and other Hispanic groups (Beckett et al 1996).…”